Provider Demographics
NPI:1760483309
Name:SMITH, GEORGIA C (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GEORGIA
Middle Name:C
Last Name:SMITH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1001 WEATHERSTONE PKWY
Mailing Address - Street 2:SUITE 430
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-4495
Mailing Address - Country:US
Mailing Address - Phone:770-592-0150
Mailing Address - Fax:770-592-0971
Practice Address - Street 1:1001 WEATHERSTONE PKWY
Practice Address - Street 2:SUITE 430
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-4495
Practice Address - Country:US
Practice Address - Phone:770-592-0150
Practice Address - Fax:770-592-0971
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1754103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00583921AMedicaid