Provider Demographics
NPI:1457308728
Name:DENNIS SMITH, RACHELLE L (MD)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:L
Last Name:DENNIS SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RACHELLE
Other - Middle Name:
Other - Last Name:LAURICE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3088 CAMPBELLTON RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311
Mailing Address - Country:US
Mailing Address - Phone:404-344-2828
Mailing Address - Fax:404-344-8384
Practice Address - Street 1:3088 CAMPBELLTON RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311
Practice Address - Country:US
Practice Address - Phone:404-344-2828
Practice Address - Fax:404-344-8384
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA027531208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
E01097Medicare UPIN