Provider Demographics
NPI:1376594770
Name:SMITH, YVONNE L (MD)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YVONNE
Other - Middle Name:LORRAINE
Other - Last Name:ARMSTRONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4910 JONESBORO RD
Mailing Address - Street 2:BLDG. 700, STE. 1
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-2085
Mailing Address - Country:US
Mailing Address - Phone:770-964-7736
Mailing Address - Fax:770-306-1726
Practice Address - Street 1:4910 JONESBORO RD
Practice Address - Street 2:BLDG. 700, STE. 1
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-2085
Practice Address - Country:US
Practice Address - Phone:770-964-7736
Practice Address - Fax:770-306-1726
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042443208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
E62538Medicare UPIN
GA11BDRKTMedicare Oscar/Certification