MEDICARE: JOSEPH CARL SMIDDY MD

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	207R00000X	Internal Medicine Physician	042728	GA

General Provider Information

NPI Number	:	1841246006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH CARL SMIDDY MD

Provider Business Mailing Address
First Line	:	1700 BRIARCLIFF RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-2106
Country	:	US
Telephone Number	:	404-228-2648
Fax Number	:	404-228-7556

Provider Business Practice Location Address
First Line	:	1700 BRIARCLIFF RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-2106
Country	:	US
Telephone Number	:	404-228-2648
Fax Number	:	404-228-7556

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

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	10/03/2014

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