Provider Demographics
NPI:1619374600
Name:SMITH, ANTHONY STEPHONE
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:STEPHONE
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 COOPER WOODS DR
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-8207
Mailing Address - Country:US
Mailing Address - Phone:678-760-5921
Mailing Address - Fax:
Practice Address - Street 1:3210 COOPER WOODS DR
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-8207
Practice Address - Country:US
Practice Address - Phone:678-760-5921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator