Provider Demographics
NPI:1891861266
Name:SMITH, EMORY POWERS III (MD)
Entity Type:Individual
Prefix:MR
First Name:EMORY
Middle Name:POWERS
Last Name:SMITH
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:658 NORTHSIDE DRIVE EAST
Mailing Address - Street 2:SUITE B
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458
Mailing Address - Country:US
Mailing Address - Phone:912-871-8719
Mailing Address - Fax:912-587-2256
Practice Address - Street 1:658 NORTHSIDE DRIVE EAST
Practice Address - Street 2:SUITE B
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458
Practice Address - Country:US
Practice Address - Phone:912-871-8719
Practice Address - Fax:912-587-2256
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2015-07-16
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Provider Licenses
StateLicense IDTaxonomies
GA025281207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00302794BMedicaid
GA11BDCQXMedicare PIN
GA00302794BMedicaid