Provider Demographics
NPI:1376520874
Name:SMITH, RICHARD C (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:C
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:611 E VILLANOW ST
Mailing Address - Street 2:
Mailing Address - City:LA FAYETTE
Mailing Address - State:GA
Mailing Address - Zip Code:30728-2618
Mailing Address - Country:US
Mailing Address - Phone:706-638-1606
Mailing Address - Fax:706-861-9405
Practice Address - Street 1:611 E VILLANOW ST
Practice Address - Street 2:
Practice Address - City:LA FAYETTE
Practice Address - State:GA
Practice Address - Zip Code:30728-2618
Practice Address - Country:US
Practice Address - Phone:706-638-1606
Practice Address - Fax:706-861-9405
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA19603207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA08BBWXVMedicare PIN