Individual
LARRY E SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5116 NORTHWIND BLVD, VALDOSTA, GA 31605
(294) 604-3292
Mailing address
5116 NORTHWIND BLVD, VALDOSTA, GA 31605-7672
(294) 604-3292
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
037694
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00793284A
—
GA
Enumeration date
06/27/2006
Last updated
05/25/2019
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