Provider Demographics
NPI:1992769202
Name:SMITH, GREGORY ALLEN (MD)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:ALLEN
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:315 BLVD NE
Mailing Address - Street 2:STE 336
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312
Mailing Address - Country:US
Mailing Address - Phone:404-522-4888
Mailing Address - Fax:404-581-0379
Practice Address - Street 1:315 BLVD NE
Practice Address - Street 2:STE 336
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312
Practice Address - Country:US
Practice Address - Phone:404-522-4888
Practice Address - Fax:404-581-0379
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034511207V00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
024912OtherBCBS
GA000461128Medicaid
480791OtherAETNA
GA000461128Medicaid
480791OtherAETNA