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NPI Code Detail

MEDICARE: S T SMITH JR.

MEDICARE: S T SMITH JR.
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
12471C3402XRadiography Radiologic Technologist460241GA

General Provider Information

NPI Number : 1841146776
Entity Type Code : Individual
Provider Name (Legal Business Name) : S T SMITH JR.
Provider Business Mailing Address
First Line : 3419 OWENS PASS NW
Second Line :
City : KENNESAW
State : GA
Zip : 30152-2583
Country : US
Telephone Number : 267-616-3768
Fax Number :
Provider Business Practice Location Address
First Line : 1670 CLAIRMONT RD
Second Line :
City : DECATUR
State : GA
Zip : 30033-4004
Country : US
Telephone Number : 404-321-6111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/04/2026
Last Update Date : 03/04/2026

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Directions to “ S T SMITH JR. ” Practice Location

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