Provider Demographics
NPI:1215140496
Name:SMITH, TAMORIE (MD)
Entity type:Individual
Prefix:
First Name:TAMORIE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6228 BRADLEY PARK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-3603
Mailing Address - Country:US
Mailing Address - Phone:706-322-1486
Mailing Address - Fax:706-324-3419
Practice Address - Street 1:6228 BRADLEY PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-3603
Practice Address - Country:US
Practice Address - Phone:706-322-1486
Practice Address - Fax:706-324-3419
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA062776207RN0300X
AL27203207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I393771OtherMEDICARE
GAP00771338OtherRAILROAD MEDICARE
AL102I397401OtherMEDICARE
GA812706846BMedicaid
AL114966Medicaid
AL114995Medicaid
AL51049544OtherBCBS AL
GA60055514OtherBCBS AL
GA52324622OtherBCBS GA
GA812706846AMedicaid