Provider Demographics
NPI:1932345402
Name:SMITH, MATTHEW LOUIS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:LOUIS
Last Name:SMITH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3803 NOBLE CREEK DR NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-1070
Mailing Address - Country:US
Mailing Address - Phone:678-849-5688
Mailing Address - Fax:
Practice Address - Street 1:1401 PEACHTREE ST NE STE 500
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3041
Practice Address - Country:US
Practice Address - Phone:678-849-5688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003247103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist