Provider Demographics
NPI:1235300369
Name:SMITH, DONALD RAY (CAC-II)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:RAY
Last Name:SMITH
Suffix:
Gender:M
Credentials:CAC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3970 GOLDEN ISLE E
Mailing Address - Street 2:
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31513-7216
Mailing Address - Country:US
Mailing Address - Phone:912-367-4614
Mailing Address - Fax:
Practice Address - Street 1:3970 GOLDEN ISLE E
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-7216
Practice Address - Country:US
Practice Address - Phone:912-367-4614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1759101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)