Provider Demographics
NPI:1073684460
Name:SMITH, JOSEPH M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:M
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 BROOKS RD
Mailing Address - Street 2:
Mailing Address - City:BROOKS
Mailing Address - State:GA
Mailing Address - Zip Code:30205-2302
Mailing Address - Country:US
Mailing Address - Phone:765-977-3669
Mailing Address - Fax:
Practice Address - Street 1:474 BROOKS RD
Practice Address - Street 2:
Practice Address - City:BROOKS
Practice Address - State:GA
Practice Address - Zip Code:30205-2302
Practice Address - Country:US
Practice Address - Phone:765-977-3669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043427207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200022790AMedicaid
F01681Medicare UPIN
IN200022790AMedicaid