Provider Demographics
NPI:1700977550
Name:SMITH, WILLIAM STUART (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:STUART
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3614 J DEWEY GRAY CIR STE A
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6512
Mailing Address - Country:US
Mailing Address - Phone:706-863-5635
Mailing Address - Fax:706-860-3462
Practice Address - Street 1:3614 J DEWEY GRAY CIR STE A
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6512
Practice Address - Country:US
Practice Address - Phone:706-863-5635
Practice Address - Fax:706-860-3462
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014569207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD91012Medicare UPIN