Provider Demographics
NPI:1285606012
Name:SMITH, CRAIG EVAN (MD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:EVAN
Last Name:SMITH
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 ABERDEEN RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1393
Mailing Address - Country:US
Mailing Address - Phone:229-436-1361
Mailing Address - Fax:229-436-3034
Practice Address - Street 1:420 CHARTER BLVD STE 402
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-0722
Practice Address - Country:US
Practice Address - Phone:478-779-6130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028464207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF54518Medicare UPIN