Provider Demographics
NPI:1164769527
Name:SNOWDEN, MILES SMITH (MD)
Entity Type:Individual
Prefix:DR
First Name:MILES
Middle Name:SMITH
Last Name:SNOWDEN
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 1:3121 W 69TH ST
Mailing Address - Street 2:APT 114
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2559
Mailing Address - Country:US
Mailing Address - Phone:404-405-3715
Mailing Address - Fax:
Practice Address - Street 1:3121 W 69TH ST
Practice Address - Street 2:APT 114
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2559
Practice Address - Country:US
Practice Address - Phone:404-405-3715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-05
Last Update Date:2013-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA473672083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine