Provider Demographics
NPI:1295969947
Name:SMITH, DENISE ANNE (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:ANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DUNWOODY PARK STE 130
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6714
Mailing Address - Country:US
Mailing Address - Phone:404-554-2080
Mailing Address - Fax:404-554-8021
Practice Address - Street 1:2631 CENTENNIAL BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-0588
Practice Address - Country:US
Practice Address - Phone:850-877-8539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00892782086S0129X
OH35.0991032086S0129X
VA01012691302086S0129X
CAA1313962086S0129X
FLME1291042086S0129X
GA956082086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery