Provider Demographics
NPI:1164467106
Name:SMITH, JAMES F JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:F
Last Name:SMITH
Suffix:JR
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 1:1062 FORSYTH ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-8637
Mailing Address - Country:US
Mailing Address - Phone:478-743-7068
Mailing Address - Fax:478-741-1354
Practice Address - Street 1:1062 FORSYTH ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-8637
Practice Address - Country:US
Practice Address - Phone:478-743-7068
Practice Address - Fax:478-741-1354
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA15424174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD42227Medicare UPIN
GA5125010001Medicare NSC
GA90BDBJMMedicare ID - Type Unspecified