Provider Demographics
NPI:1295832004
Name:SMITH, JAMES K (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:K
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4480 N COOPER LAKE RD SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-4622
Mailing Address - Country:US
Mailing Address - Phone:470-644-0122
Mailing Address - Fax:770-333-2059
Practice Address - Street 1:4480 N COOPER LAKE RD SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082
Practice Address - Country:US
Practice Address - Phone:470-644-0122
Practice Address - Fax:770-333-2059
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI71995207RR0500X
ORMD21033207RR0500X
GA033199207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR151104Medicaid
OR151104Medicaid
OR100184Medicare ID - Type Unspecified