Provider Demographics
NPI:1538173935
Name:SMITH, DOUGLAS E (PT)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:E
Last Name:SMITH
Suffix:
Gender:M
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:PO BOX 541
Mailing Address - Street 2:
Mailing Address - City:CATAULA
Mailing Address - State:GA
Mailing Address - Zip Code:31804-0541
Mailing Address - Country:US
Mailing Address - Phone:706-322-2271
Mailing Address - Fax:706-322-2220
Practice Address - Street 1:6501 VETERANS PKWY
Practice Address - Street 2:SUTIE 1F
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-3169
Practice Address - Country:US
Practice Address - Phone:706-322-2271
Practice Address - Fax:706-322-2220
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT001977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist