Individual
SUMONA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1404 RIVER PL, SUITE 201, BRASELTON, GA 30517-5600
(770) 219-4000
(770) 219-4001
Mailing address
PO BOX 742616, ATLANTA, GA 30374-2616
(770) 219-8420
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
054343
GA
208600000X
Surgery Physician
21693
MS
2086S0129X
Vascular Surgery Physician
Primary
054343
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
174387
—
AL
05
—
2359673
—
LA
01
—
P01006900
RAILROAD MEDICARE PTAN
MS
01
—
P01251951
RAILROAD MEDICARE
MS
Enumeration date
12/31/2007
Last updated
10/15/2020
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