Provider Demographics
NPI:1467796680
Name:SMITH, ANDREW C (DPT)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:C
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:921 MOORES FERRY RD
Practice Address - Street 2:STE D
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-9703
Practice Address - Country:US
Practice Address - Phone:678-840-8881
Practice Address - Fax:678-840-8885
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 27713225100000X
GA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist