Provider Demographics
NPI:1467444570
Name:MITCHELL-SMITH, LA'GENIA (DPM)
Entity Type:Individual
Prefix:DR
First Name:LA'GENIA
Middle Name:
Last Name:MITCHELL-SMITH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CIRCLE 75 PKWY.SE
Mailing Address - Street 2:SUITE 900
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3084
Mailing Address - Country:US
Mailing Address - Phone:678-426-2171
Mailing Address - Fax:404-446-1957
Practice Address - Street 1:550 PEACHTREE STREET
Practice Address - Street 2:SUITE 1960
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2225
Practice Address - Country:US
Practice Address - Phone:404-589-1330
Practice Address - Fax:404-589-1387
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001024213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAV05680Medicare UPIN
GA48SCCSWMedicare PIN
GA48SCCSWMedicare PIN