Individual
IVY YVONNE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
120 HANDLEY RD, STE 410, TYRONE, GA 30290-1625
(770) 964-5810
(678) 364-1216
Mailing address
120 HANDLEY RD, STE 410, TYRONE, GA 30290-1625
(770) 964-5810
(678) 364-1216
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
053075
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
407530212B
—
GA
Enumeration date
09/14/2006
Last updated
07/21/2008
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