1891879995 NPI number — SMITH-LOCKWOOD, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891879995 NPI number — SMITH-LOCKWOOD, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SMITH-LOCKWOOD, INC.
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:
Provider Other Organization Name Type Code:
6
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:
1891879995
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:
PO BOX 308
Provider Second Line Business Mailing Address:
114 S MARBLE ST
Provider Business Mailing Address City Name:
ROCKMART
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30153-0308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-684-6573
Provider Business Mailing Address Fax Number:
770-684-4553

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
114 S MARBLE STREET
Provider Second Line Business Practice Location Address:
ROCKM
Provider Business Practice Location Address City Name:
ROCKMART
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-684-7889
Provider Business Practice Location Address Fax Number:
770-684-1550
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VEST
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
NELSON
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
770-684-6573

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  00035879 , 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: 005696 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000035879A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8442448-YI . This is a "GA STATE TAX ID#" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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