Smith, Kathleen Jeanne

Smith, Kathleen Jeanne is an individual health care provider with primary practice located at 1670 Scott Blvd Ste 202 , Decatur GA 30033-5645. She recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Dermatology, Allopathic & Osteopathic Physicians / Dermatopathology, Allopathic & Osteopathic Physicians / Immunopathology. Allopathic & Osteopathic Physicians / Dermatopathology is her primary health care specialty. Smith, Kathleen Jeanne can be contacted via phone (678) 904-4932.

Contact Information

Primary practice address
1670 Scott Blvd Ste 202 Decatur GA 30033-5645
Phone: (678) 904-4932
Fax: (470) 428-2869
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 053035 Georgia
Allopathic & Osteopathic Physicians / Dermatopathology 207ZD0900X 053035 Georgia
Allopathic & Osteopathic Physicians / Immunopathology 207ZI0100X 053035 Georgia

Profile Details

NPI number 1396916219
LBN Legal business name Smith, Kathleen Jeanne
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 19th, 2008
Last updated Oct 4th, 2016 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1396916219 NPPES
Georgia MEDICAID 090074158A
Georgia Other 460052

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