Individual
WENDY L SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
11 HOSPITAL WAY, BLAIRSVILLE, GA 30512-3144
(706) 745-1305
(706) 745-8463
Mailing address
11 HOSPITAL WAY, BLAIRSVILLE, GA 30512-3144
(706) 745-1305
(706) 745-8463
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
01064593A
IN
207Y00000X
Otolaryngology Physician
Primary
049746
GA
207Y00000X
Otolaryngology Physician
200100094
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000913756C
—
GA
01
—
04BDCJH
GEORGIA MEDICARE
GA
01
—
821243
BLUE CROSS BLUE SHIELD
GA
01
—
89065FT
MEDICAID
NC
Enumeration date
06/12/2006
Last updated
06/10/2015
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