Provider Demographics
NPI:1407038664
Name:SMITH, CORINNE G (MD)
Entity Type:Individual
Prefix:DR
First Name:CORINNE
Middle Name:G
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 OLD MILTON PKWY # C
Mailing Address - Street 2:STE 565
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-3707
Mailing Address - Country:US
Mailing Address - Phone:770-664-1012
Mailing Address - Fax:770-664-5543
Practice Address - Street 1:3400 OLD MILTON PKWY # C
Practice Address - Street 2:STE 565
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3707
Practice Address - Country:US
Practice Address - Phone:770-664-1012
Practice Address - Fax:770-664-5543
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA45970207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00799301CMedicaid
GA00799301CMedicaid
GA07BBSGRMedicare PIN