Provider Demographics
NPI:1518499417
Name:SMITH, JOSE THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:THOMAS
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 1:137 MICHELLE DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-4536
Mailing Address - Country:US
Mailing Address - Phone:740-260-0888
Mailing Address - Fax:740-240-0516
Practice Address - Street 1:137 MICHELLE DR
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-4536
Practice Address - Country:US
Practice Address - Phone:740-260-0088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020037209208D00000X
MN69856208D00000X
GA89857208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice