Individual
DR. RONNIE R SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
200 MAPLE DR, VIDALIA, GA 30474-8907
(912) 537-9851
(912) 537-9843
Mailing address
PO BOX 1367, 200 MAPLE DRIVE, VIDALIA, GA 30475-1367
(912) 537-9851
(912) 537-9843
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
017886
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000144867A
—
GA
01
—
204764
STATE HEALTH BENEFITS
GA
01
—
408113438
RAILROAD MEDICARE
GA
01
—
581356947
PRACTICE FEDERAL TAX ID
GA
Enumeration date
08/24/2005
Last updated
03/24/2014
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