Provider Demographics
NPI:1427039254
Name:SIDNEY P SMITH MD PC
Entity Type:Organization
Organization Name:SIDNEY P SMITH MD PC
Other - Org Name:GEORGIA SKIN AND CANCER CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:P
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:912-925-0067
Mailing Address - Street 1:900 MOHAWK ST
Mailing Address - Street 2:E
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1780
Mailing Address - Country:US
Mailing Address - Phone:912-925-0067
Mailing Address - Fax:912-927-0267
Practice Address - Street 1:900 MOHAWK ST
Practice Address - Street 2:E
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1780
Practice Address - Country:US
Practice Address - Phone:912-925-0067
Practice Address - Fax:912-927-0267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological ImmunologyGroup - Multi-Specialty
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric DermatologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGPA574Medicaid
GAGRP2950Medicare ID - Type Unspecified
GACI1426Medicare ID - Type UnspecifiedRAILROAD MEDICARE
SC8312Medicare ID - Type Unspecified