Provider Demographics
NPI:1366553901
Name:SMITH, TANIA (MD)
Entity type:Individual
Prefix:DR
First Name:TANIA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 POINTE NORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-1513
Mailing Address - Country:US
Mailing Address - Phone:229-903-4044
Mailing Address - Fax:229-903-4055
Practice Address - Street 1:600 POINTE NORTH BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31721-1513
Practice Address - Country:US
Practice Address - Phone:229-903-4044
Practice Address - Fax:229-903-4055
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051602208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA008748OtherBCBS - EMC
GA000962035AMedicaid
GA008749OtherBCBS - EAPC
GA370021488OtherRR MCARE - EAPC
GA7383379OtherAETNA
GA370021505OtherRR MCARE - EMC
GA008748OtherBCBS - EMC
GAH63588Medicare UPIN