Provider Demographics
NPI:1023043130
Name:SMITH, RICHARD LYNDON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LYNDON
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 8309
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31095-8309
Mailing Address - Country:US
Mailing Address - Phone:478-929-4100
Mailing Address - Fax:478-329-8814
Practice Address - Street 1:1260 RUSSELL PKWY
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-5540
Practice Address - Country:US
Practice Address - Phone:478-929-4100
Practice Address - Fax:478-329-8814
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-11-01
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Provider Licenses
StateLicense IDTaxonomies
GA021818207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD91004Medicare UPIN