Individual
LARRY RAY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
330 HAWTHORNE LN, ATHENS, GA 30606-2152
(706) 613-8500
Mailing address
PO BOX 603725, CHARLOTTE, NC 28260-3725
(828) 575-2625
(828) 350-2174
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
23506
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000287328N
—
GA
05
—
000287328O
—
GA
01
—
MEDICARE
202I034440
GA
Enumeration date
12/21/2005
Last updated
10/18/2023
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