Provider Demographics
NPI:1376764498
Name:SMITH, WALTER TORRENCE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:TORRENCE
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:3384 PEACHTREE RD NE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1181
Mailing Address - Country:US
Mailing Address - Phone:770-626-5740
Mailing Address - Fax:770-626-5585
Practice Address - Street 1:3384 PEACHTREE RD NE
Practice Address - Street 2:SUITE 700
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1181
Practice Address - Country:US
Practice Address - Phone:770-626-5740
Practice Address - Fax:770-626-5585
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2015-11-25
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Provider Licenses
StateLicense IDTaxonomies
GA037078207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511G700201Medicare PIN
GAF64458Medicare UPIN
GA202I080452Medicare UPIN