Provider Demographics
NPI:1073372983
Name:SEIDU SMITH, SAFIA AMADU (LDO)
Entity Type:Individual
Prefix:
First Name:SAFIA
Middle Name:AMADU
Last Name:SEIDU SMITH
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 CENTERVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-6117
Mailing Address - Country:US
Mailing Address - Phone:770-972-2250
Mailing Address - Fax:770-972-0678
Practice Address - Street 1:3435 CENTERVILLE HWY
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-6117
Practice Address - Country:US
Practice Address - Phone:770-972-2250
Practice Address - Fax:770-972-0678
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO002485156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician