Provider Demographics
NPI:1700833753
Name:SMITH, RONNIE E (MD)
Entity Type:Individual
Prefix:
First Name:RONNIE
Middle Name:E
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:365 N JEFF DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214
Mailing Address - Country:US
Mailing Address - Phone:770-461-5003
Mailing Address - Fax:770-461-4939
Practice Address - Street 1:543 JONESBORO RD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253
Practice Address - Country:US
Practice Address - Phone:770-461-5003
Practice Address - Fax:770-461-4939
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA045338208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics