1215140496 NPI number — TAMORIE SMITH MD

Table of content: TAMORIE SMITH MD (NPI 1215140496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215140496 NPI number — TAMORIE SMITH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
TAMORIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1215140496
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6228 BRADLEY PARK DR
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31904-3603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-322-1486
Provider Business Mailing Address Fax Number:
706-324-3419

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6228 BRADLEY PARK DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31904-3603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-322-1486
Provider Business Practice Location Address Fax Number:
706-324-3419
Provider Enumeration Date:
05/07/2007

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: 207RN0300X , with the licence number:  062776 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RN0300X , with the licence number: 27203 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 202I393771 . This is a "MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: P00771338 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 102I397401 . This is a "MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 812706846B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114966 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114995 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51049544 . This is a "BCBS AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 60055514 . This is a "BCBS AL" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 52324622 . This is a "BCBS GA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 812706846A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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