Provider Demographics
NPI:1811045362
Name:SMITH, KEVIN MADRAS (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:MADRAS
Last Name:SMITH
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 1:2410 SYLVESTER RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31705-2479
Mailing Address - Country:US
Mailing Address - Phone:229-312-9200
Mailing Address - Fax:
Practice Address - Street 1:803 N JEFFERSON ST STE C
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-5117
Practice Address - Country:US
Practice Address - Phone:229-312-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0572722083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine