Provider Demographics
NPI:1811127673
Name:SMITH, NICHOLAS CRAIG (DPM)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:CRAIG
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1013 CENTRE BROOK CT
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-4573
Mailing Address - Country:US
Mailing Address - Phone:706-653-5501
Mailing Address - Fax:706-653-5504
Practice Address - Street 1:1013 CENTRE BROOK COURT
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-4573
Practice Address - Country:US
Practice Address - Phone:706-653-5501
Practice Address - Fax:706-653-5504
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL135000690213E00000X
GAPOD001207213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0436482793000OtherEMPOLYER ID