NPI 1003366840

Derrick Smith

Practitioner Contractor Leesburg, GA

Practice location

Address: 100 Medley Dr, Leesburg, GA 31763-3272
Phone: (229) 343-8849

Registered specialties

Contractor Primary

Other Service Providers Taxonomy 171W00000X Licence 17100000X (GA)

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Registry record

NPI: 1003366840
Entity type: Individual
Sex (as registered): Male
NPI issued: 5 Oct 2016
Record last updated: 5 Oct 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.