1174782452 NPI number — DR. MICHELE S SMITH PHD

Table of content: DR. MICHELE S SMITH PHD (NPI 1174782452)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174782452 NPI number — DR. MICHELE S SMITH PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
MICHELE
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174782452
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 CORPORATE CENTER DR STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORROW
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30260-4129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-968-6464
Provider Business Mailing Address Fax Number:
770-968-6465

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 CORPORATE CENTER DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
MORROW
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30260-4180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-968-6380
Provider Business Practice Location Address Fax Number:
770-968-6465
Provider Enumeration Date:
06/03/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFT001178 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: MFC43092 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)