Provider Demographics
NPI:1487824918
Name:SMITH, DANNIE CARROLL (PT, ECS)
Entity Type:Individual
Prefix:MR
First Name:DANNIE
Middle Name:CARROLL
Last Name:SMITH
Suffix:
Gender:M
Credentials:PT, ECS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 DOGWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-4911
Mailing Address - Country:US
Mailing Address - Phone:706-647-6218
Mailing Address - Fax:706-647-3480
Practice Address - Street 1:42 DOGWOOD TRL
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-4911
Practice Address - Country:US
Practice Address - Phone:706-647-6218
Practice Address - Fax:706-647-3480
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0008192251E1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical