Provider Demographics
NPI:1053329268
Name:SMITH, DON T JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DON
Middle Name:T
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 7083
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-7083
Mailing Address - Country:US
Mailing Address - Phone:229-391-2910
Mailing Address - Fax:229-386-4770
Practice Address - Street 1:415 E 4TH AVE STE B
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-0614
Practice Address - Country:US
Practice Address - Phone:229-391-2910
Practice Address - Fax:229-386-4770
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA042122207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000882OtherBLUE CROSS PROVIDER #
GA000825866DMedicaid
GA000882OtherBLUE CROSS PROVIDER #
GA05BDKZLMedicare ID - Type UnspecifiedPROVIDER NUMBER