Provider Demographics
NPI:1386608818
Name:SMITH, SARA C (MD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:C
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6602 DELYNN DR
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-2219
Mailing Address - Country:US
Mailing Address - Phone:229-391-3640
Mailing Address - Fax:229-391-3686
Practice Address - Street 1:907 18TH ST E
Practice Address - Street 2:SUITE 400
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-3643
Practice Address - Country:US
Practice Address - Phone:229-391-3640
Practice Address - Fax:229-391-3686
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029618174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist