Provider Demographics
NPI:1013069095
Name:SMITH, TONY E (DC)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:E
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 W DYKES ST
Mailing Address - Street 2:
Mailing Address - City:COCHRAN
Mailing Address - State:GA
Mailing Address - Zip Code:31014-0845
Mailing Address - Country:US
Mailing Address - Phone:478-934-8801
Mailing Address - Fax:478-934-8887
Practice Address - Street 1:136 W DYKES ST
Practice Address - Street 2:
Practice Address - City:COCHRAN
Practice Address - State:GA
Practice Address - Zip Code:31014-0845
Practice Address - Country:US
Practice Address - Phone:478-934-8801
Practice Address - Fax:478-934-8887
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005184111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU49260Medicare UPIN
GA35ZCHHGMedicare ID - Type Unspecified