Individual
KEVIN F SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4450 NELSON BROGDON BLVD, SUITE D1, BUFORD, GA 30518-3447
(770) 932-9998
(770) 457-3018
Mailing address
300 COLONIAL CENTER PKWY, SUITE 100, ROSWELL, GA 30076-4899
(770) 286-9149
(770) 457-3018
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
041961
GA
207QA0505X
Adult Medicine Physician
041961
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52614729-001
BLUE CROSS
GA
Enumeration date
07/18/2005
Last updated
04/28/2021
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