Provider Demographics
NPI:1730262759
Name:ROBERT S. SMITH MD, INC
Entity type:Organization
Organization Name:ROBERT S. SMITH MD, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF LABORATORY
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:888-581-1201
Mailing Address - Street 1:11390 OLD ROSWELL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-2058
Mailing Address - Country:US
Mailing Address - Phone:888-581-1201
Mailing Address - Fax:866-240-2442
Practice Address - Street 1:11390 OLD ROSWELL RD STE 100
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-2058
Practice Address - Country:US
Practice Address - Phone:770-817-0920
Practice Address - Fax:866-240-2442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044-141291U00000X
GA019473207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP1180Medicare PIN
GA220005525Medicare PIN