Provider Demographics
NPI:1326012519
Name:SMITH, CHADWICK A
Entity Type:Individual
Prefix:DR
First Name:CHADWICK
Middle Name:A
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 ERLANGER SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-3179
Mailing Address - Country:US
Mailing Address - Phone:423-778-6784
Mailing Address - Fax:423-778-7035
Practice Address - Street 1:60 ERLANGER SOUTH DR
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-3179
Practice Address - Country:US
Practice Address - Phone:423-778-6784
Practice Address - Fax:423-778-7035
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA51552207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000962057DMedicaid
GA000962057DMedicaid