Provider Demographics
NPI:1568480226
Name:DAILEY-SMITH, MARY F (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:F
Last Name:DAILEY-SMITH
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:5610 WENDY BAGWELL PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141
Mailing Address - Country:US
Mailing Address - Phone:770-943-7808
Mailing Address - Fax:770-943-7805
Practice Address - Street 1:1008 N PIEDMONT AVE
Practice Address - Street 2:
Practice Address - City:ROCKMART
Practice Address - State:GA
Practice Address - Zip Code:30153-2526
Practice Address - Country:US
Practice Address - Phone:770-684-6100
Practice Address - Fax:770-684-8294
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2016-02-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA050472207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA662717317AMedicaid
GAH50558Medicare UPIN
GA662717317AMedicaid