Provider Demographics
NPI:1376586958
Name:SMITH, CARRIE D (MD)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:D
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:204 PROFESSIONAL CT SE
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-7020
Mailing Address - Country:US
Mailing Address - Phone:706-625-5900
Mailing Address - Fax:706-625-6519
Practice Address - Street 1:204 PROFESSIONAL CT SE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-7020
Practice Address - Country:US
Practice Address - Phone:706-625-5900
Practice Address - Fax:706-625-6519
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045059174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA37BBHBDMedicare ID - Type Unspecified
GAH47905Medicare UPIN