Provider Demographics
NPI:1740382894
Name:SMITH, TAMMY G (MD)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:G
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 HIGHWAY 129 N
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:GA
Mailing Address - Zip Code:30549-2652
Mailing Address - Country:US
Mailing Address - Phone:706-367-1010
Mailing Address - Fax:706-367-1050
Practice Address - Street 1:2610 HWY 129 N
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:GA
Practice Address - Zip Code:30549
Practice Address - Country:US
Practice Address - Phone:706-367-1010
Practice Address - Fax:706-367-1050
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038372261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000608253HMedicaid