1538354980 NPI number — CRAIG E. SMITH, MD, PC

Table of content: (NPI 1538354980)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538354980 NPI number — CRAIG E. SMITH, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRAIG E. SMITH, MD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
INFECTIOUS DISEASES CONSULTANTS OF SOUTHWEST GEORGIA
Provider Other Organization Name Type Code:
3
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:
1538354980
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1909 ABERDEEN RD
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31701-1393
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-436-1361
Provider Business Mailing Address Fax Number:
229-436-3034

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1909 ABERDEEN RD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31701-1393
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-436-1361
Provider Business Practice Location Address Fax Number:
229-436-3034
Provider Enumeration Date:
09/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
OWNER / PRESIDENT
Authorized Official Telephone Number:
229-436-1361

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  028464 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: F54518 . This is a "UPIN #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1285606012 . This is a "INDIVIDUAL NPI #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 028464 . This is a "GEORGIA MEDICAL LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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