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General NPI Number Information
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NPI Number | 1881828713
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Entity Type | Individual
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Provider Name | CICELY PATRICE DOWDELL-SMITH MD
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Gender | Female
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Dates
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Enumeration Date | 05/06/2009
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Last Update Date | 10/31/2019
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Provider Practice Location Address
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Address Line | 3747 ROSWELL RD STE 201
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City | MARIETTA
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State | GA
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Zip | 30062
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Country | US
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Telephone | 770-578-2868
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Fax | 770-971-8499
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Provider Business Mailing Address
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Address Line | 805 SANDY PLAINS ROAD MEDICAL STAFF SERVICES
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City | MARIETTA
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State | GA
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Zip | 30066-6340
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | P6607
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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License Number | 2009-00602
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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License Number | 82169
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License Number State | GA
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