Provider Demographics
NPI:1912643040
Name:SMARTMED, LLC
Entity Type:Organization
Organization Name:SMARTMED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:
Authorized Official - Last Name:LATHROP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-210-2120
Mailing Address - Street 1:1506 JONES RD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2726
Mailing Address - Country:US
Mailing Address - Phone:612-201-2120
Mailing Address - Fax:
Practice Address - Street 1:480 W CROSSVILLE RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-7502
Practice Address - Country:US
Practice Address - Phone:804-241-2130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-11
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1336185016OtherINDIVIDUAL NPI