Provider Demographics
NPI:1952321937
Name:SMITH, JOHN DORSEY (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DORSEY
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 1:602 E 72ND ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4913
Mailing Address - Country:US
Mailing Address - Phone:912-819-7800
Mailing Address - Fax:912-819-7850
Practice Address - Street 1:10 DOCTORS STREET
Practice Address - Street 2:
Practice Address - City:METTER
Practice Address - State:GA
Practice Address - Zip Code:30439
Practice Address - Country:US
Practice Address - Phone:912-685-5715
Practice Address - Fax:912-685-3737
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA14003207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD42443Medicare UPIN
GA08BBTDJMedicare ID - Type Unspecified