Individual
DERRICK SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
100 MEDLEY DR, LEESBURG, GA 31763-3272
(229) 343-8849
Mailing address
100 MEDLEY DR, LEESBURG, GA 31763-3272
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
17100000X
GA
Other
Enumeration date
10/05/2016
Last updated
10/05/2016
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