MEDICARE: DR. LA'GENIA MITCHELL-SMITH DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	POD001024	GA

General Provider Information

NPI Number	:	1467444570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LA'GENIA MITCHELL-SMITH DPM

Provider Business Mailing Address
First Line	:	900 CIRCLE 75 PKWY.SE
Second Line	:	SUITE 900
City	:	ATLANTA
State	:	GA
Zip	:	30339-3084
Country	:	US
Telephone Number	:	678-426-2171
Fax Number	:	404-446-1957

Provider Business Practice Location Address
First Line	:	550 PEACHTREE STREET
Second Line	:	SUITE 1960
City	:	ATLANTA
State	:	GA
Zip	:	30308-2225
Country	:	US
Telephone Number	:	404-589-1330
Fax Number	:	404-589-1387

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	02/03/2017

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