Individual
DR. KEVIN L SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
605 S ENOTA DR NE, GAINESVILLE, GA 30501-2437
(770) 538-0208
(770) 538-0556
Mailing address
605 S ENOTA DR NE, GAINESVILLE, GA 30501-2437
(770) 538-0208
(770) 538-0556
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
038371
GA
207ND0101X
MOHS-Micrographic Surgery Physician
038371
GA
207NS0135X
Procedural Dermatology Physician
038371
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005756529
AETNA
GA
05
—
000678983B
—
GA
01
—
070011202
RAILROAD MEDICARE
GA
01
—
1306896931
BCBS
GA
01
—
CH9982
RAILROAD MEDICARE
GA
Enumeration date
05/12/2006
Last updated
12/11/2015
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