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Individual

DUSTIN JARED SMITH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2292 PEACHTREE RD NW, ATLANTA, GA 30309-1147
(404) 996-0120
(404) 351-6762
Mailing address
3710 CLOUDLAND DR NW, ATLANTA, GA 30327-2910
(208) 585-1384

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
101661
GA
207Q00000X
Family Medicine Physician
MD156439
OR
207Q00000X
Family Medicine Physician
MR-0995
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
500640264
OR
05
808095300
ID
01
P01027050
RR MEDICARE (PROVIDENCE)
OR
Enumeration date
06/20/2008
Last updated
01/08/2026
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