Provider Demographics
NPI:1669499117
Name:COOPERSMITH, CRAIG M (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:M
Last Name:COOPERSMITH
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 1:101 WOODRUFF CIRCLE
Mailing Address - Street 2:SUITE WMB-5105
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322
Mailing Address - Country:US
Mailing Address - Phone:404-727-4273
Mailing Address - Fax:404-727-3660
Practice Address - Street 1:101 WOODRUFF CIRCLE
Practice Address - Street 2:SUITE WMB-5105
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322
Practice Address - Country:US
Practice Address - Phone:404-727-4273
Practice Address - Fax:404-727-3660
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA63310208600000X, 2086S0102X, 207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204893804Medicaid
IL$$$$$$$$$Medicaid
160050154Medicare PIN
IL$$$$$$$$$Medicaid
H13595Medicare UPIN