Provider Demographics
NPI:1417936618
Name:SMITH, MARY DOYLE (PT)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:DOYLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11660 ALPHARETTA HWY STE 115
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-3872
Mailing Address - Country:US
Mailing Address - Phone:770-992-4001
Mailing Address - Fax:770-992-4095
Practice Address - Street 1:11660 ALPHARETTA HWY STE 115
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-3872
Practice Address - Country:US
Practice Address - Phone:770-992-4001
Practice Address - Fax:770-992-4095
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004019225100000X
GA40192251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65BBBTQMedicare ID - Type Unspecified
GA584571Medicare UPIN