Provider Demographics
NPI:1144382169
Name:SMITH, JEFFRY MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFRY
Middle Name:MICHAEL
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4109 ALTAMA AVE
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-3636
Mailing Address - Country:US
Mailing Address - Phone:912-264-2424
Mailing Address - Fax:912-264-2911
Practice Address - Street 1:4109 ALTAMA AVE
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-3636
Practice Address - Country:US
Practice Address - Phone:912-264-2424
Practice Address - Fax:912-264-2911
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2011-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2236111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000654794AMedicaid
GA157407700OtherU.S. DEPT OF LABOR #
GAU40912Medicare UPIN
GA350034614Medicare ID - Type UnspecifiedRAILROAD MEDICARE PROVIDE
GA000654794AMedicaid