# SHANNON D SMITH D. C P.C

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Smith Family Chiropractic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659599645
- **Authorized official:** DR. SHANNON D SMITH D.C. (OWNER)
- **Authorized official phone:** (912) 487-2288

## Contact information

- **Practice address:** 235 N CHURCH ST, HOMERVILLE, GA 31634-2451
- **Practice address phone:** (912) 487-2288
- **Practice address fax:** (912) 487-2083
- **Mailing address:** 235 N CHURCH ST, HOMERVILLE, GA 31634-2451
- **Mailing address phone:** (912) 487-2288
- **Mailing address fax:** (912) 487-2083

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | 5479 | GA | Yes |

## Other

- **Enumeration date:** 04/23/2007
- **Last updated:** 07/12/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 35ZCDDD | PTAN | — |
| 01 | — | 511G700683 | MEDICARE GROUP PTAN | GA |