Provider Demographics
NPI:1013281948
Name:FAMILY & OCCUPATIONAL MEDICINE OF CONYERS
Entity Type:Organization
Organization Name:FAMILY & OCCUPATIONAL MEDICINE OF CONYERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-358-3427
Mailing Address - Street 1:1907 CRESCENT MOON DR NE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-2893
Mailing Address - Country:US
Mailing Address - Phone:404-358-3427
Mailing Address - Fax:
Practice Address - Street 1:1907 CRESCENT MOON DR NE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-2893
Practice Address - Country:US
Practice Address - Phone:404-358-3427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-23
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty