Provider Demographics
NPI:1407844624
Name:SMITH, ELIZABETH ANNE (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNE
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 1:11347 BIG BEND RD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-7183
Mailing Address - Country:US
Mailing Address - Phone:813-418-7282
Mailing Address - Fax:813-677-7141
Practice Address - Street 1:402 N 4TH AVE SW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2812
Practice Address - Country:US
Practice Address - Phone:706-292-3045
Practice Address - Fax:706-292-3044
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61157208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2324845OtherAETNA
FL371653800Medicaid
FL193317OtherSTAYWELL
FL593618517OtherUNITED HEALTH CARE
FL193317OtherHEALTHEASE
FL25600OtherAVMED
FL23670OtherBLUE CROSS AND BLUE SHIEL
FL593618517OtherHUMANA
FL419864003OtherCIGNA
FL419864003OtherCIGNA