Provider Demographics
NPI:1104073493
Name:SMITH, KATHY MEREDITH (DMD)
Entity type:Individual
Prefix:DR
First Name:KATHY
Middle Name:MEREDITH
Last Name:SMITH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:KATHY
Other - Middle Name:CALL
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:4875 FLOYD RD SW
Mailing Address - Street 2:SUITE 113
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-1379
Mailing Address - Country:US
Mailing Address - Phone:770-732-0900
Mailing Address - Fax:770-732-0988
Practice Address - Street 1:4875 FLOYD RD SW
Practice Address - Street 2:SUITE 113
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-1379
Practice Address - Country:US
Practice Address - Phone:770-732-0900
Practice Address - Fax:770-732-0988
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN009008122300000X
NC4591122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist