Provider Demographics
NPI:1437256401
Name:SMITH, ALAN EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:EUGENE
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SHADY OAK LN
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31411-2124
Mailing Address - Country:US
Mailing Address - Phone:912-598-1470
Mailing Address - Fax:
Practice Address - Street 1:5356 REYNOLDS ST
Practice Address - Street 2:SUITE 410
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6016
Practice Address - Country:US
Practice Address - Phone:912-355-8136
Practice Address - Fax:912-352-7014
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036294174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00738955AMedicaid
GAE42592Medicare UPIN
GA16BDFDMMedicare ID - Type Unspecified