Provider Demographics
NPI:1235171455
Name:SMITH, WENDY L (MD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HOSPITAL WAY
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-3144
Mailing Address - Country:US
Mailing Address - Phone:706-745-1305
Mailing Address - Fax:706-745-8463
Practice Address - Street 1:11 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-3144
Practice Address - Country:US
Practice Address - Phone:706-745-1305
Practice Address - Fax:706-745-8463
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049746207Y00000X
NC200100094207Y00000X
IN01064593A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA04BDCJHOtherGEORGIA MEDICARE
GA821243OtherBLUE CROSS BLUE SHIELD
GA000913756CMedicaid
NC89065FTOtherMEDICAID
GA000913756CMedicaid