Provider Demographics
NPI:1386020832
Name:SMITH, PETER E (DPM)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:E
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1975 HIGHWAY 54 W STE 205
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4794
Mailing Address - Country:US
Mailing Address - Phone:678-902-0457
Mailing Address - Fax:770-415-1450
Practice Address - Street 1:1767 ROCK QUARRY RD
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7303
Practice Address - Country:US
Practice Address - Phone:770-474-4395
Practice Address - Fax:770-474-7861
Is Sole Proprietor?:No
Enumeration Date:2015-08-07
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASC006676213E00000X
GAPOD001537213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist