Provider Demographics
NPI:1831205897
Name:SMITH, SHEILA JEANNE (DO)
Entity type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:JEANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:696 GRAYSON HIGHWAY
Mailing Address - Street 2:FAMILY PRACTICE CLINIC PC
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-6372
Mailing Address - Country:US
Mailing Address - Phone:770-963-0927
Mailing Address - Fax:770-963-9772
Practice Address - Street 1:696 GRAYSON HIGHWAY
Practice Address - Street 2:FAMILY PRACTICE CLINIC PC
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045
Practice Address - Country:US
Practice Address - Phone:770-963-0927
Practice Address - Fax:770-963-9772
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2010-08-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA20001207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00168869AMedicaid
E61261Medicare UPIN
GA00168869AMedicaid