Provider Demographics
NPI:1063444628
Name:SMITH, ROYSHANDA CZELL (MD)
Entity Type:Individual
Prefix:MS
First Name:ROYSHANDA
Middle Name:CZELL
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1800 PEACHTREE ROAD, NW
Mailing Address - Street 2:SUITE 650
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309
Mailing Address - Country:US
Mailing Address - Phone:678-539-5980
Mailing Address - Fax:678-686-1715
Practice Address - Street 1:1800 PEACHTREE ROAD, NW
Practice Address - Street 2:SUITE 650
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309
Practice Address - Country:US
Practice Address - Phone:678-539-5980
Practice Address - Fax:678-539-5981
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA69962207V00000X
LAMD199923R207V00000X
AL29098207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1052159Medicaid
MS02527821Medicaid
AL510IL60066Medicare PIN