Provider Demographics
NPI:1770640633
Name:SMITH, AUBREY (LOP)
Entity type:Individual
Prefix:MR
First Name:AUBREY
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:LOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 HICKORY SPRINGS IND DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-7933
Mailing Address - Country:US
Mailing Address - Phone:770-345-6899
Mailing Address - Fax:770-345-7341
Practice Address - Street 1:95 HICKORY SPRINGS IND DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-7933
Practice Address - Country:US
Practice Address - Phone:770-345-6899
Practice Address - Fax:770-345-7341
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7700620Medicaid
NC7700620Medicaid