MEDICARE: DR. JAMES KEITH SMITH D.M.D.

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	1223G0001X	General Practice Dentistry	DN011118	GA

General Provider Information

NPI Number	:	1669573887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES KEITH SMITH D.M.D.

Provider Business Mailing Address
First Line	:	1777 LEE RD
Second Line	:	SUITE D
City	:	LITHIA SPRINGS
State	:	GA
Zip	:	30122-3073
Country	:	US
Telephone Number	:	770-948-1600
Fax Number	:	770-948-4374

Provider Business Practice Location Address
First Line	:	1777 LEE RD
Second Line	:	SUITE D
City	:	LITHIA SPRINGS
State	:	GA
Zip	:	30122-3073
Country	:	US
Telephone Number	:	770-948-1600
Fax Number	:	770-948-4374

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	07/08/2007

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