Provider Demographics
NPI:1861925752
Name:SMITH, RYAN DOUGLAS (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:DOUGLAS
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:740 RALPH MCGILL BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1118
Mailing Address - Country:US
Mailing Address - Phone:404-251-1740
Mailing Address - Fax:404-332-3384
Practice Address - Street 1:740 RALPH MCGILL BLVD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1118
Practice Address - Country:US
Practice Address - Phone:404-251-1740
Practice Address - Fax:404-332-3384
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA85130207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine