Provider Demographics
NPI:1417021221
Name:SMITH, JEFFREY GRANT (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:GRANT
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4298 MEMORIAL DRIVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-1228
Mailing Address - Country:US
Mailing Address - Phone:404-292-7614
Mailing Address - Fax:404-292-5080
Practice Address - Street 1:4298 MEMORIAL DRIVE
Practice Address - Street 2:SUITE D
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-1228
Practice Address - Country:US
Practice Address - Phone:404-292-7614
Practice Address - Fax:404-292-5080
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAG525111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor