Individual
DR. KATHLEEN JEANNE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1670 SCOTT BLVD STE 202, DECATUR, GA 30033-5645
(678) 904-4932
(470) 428-2869
Mailing address
1670 SCOTT BLVD STE 202, DECATUR, GA 30033-5645
(678) 904-4932
(470) 428-2869
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
053035
GA
207ZD0900X
Dermatopathology (Pathology) Physician
Primary
053035
GA
207ZI0100X
Immunopathology Physician
053035
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
090074158A
—
GA
01
—
460052
WELLCARE
GA
Enumeration date
03/19/2008
Last updated
10/04/2016
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