Basic Information
| Provider Information | |||||||||
| NPI: | 1689899684 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | CLENTERA | ||||||||
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| Credential: | D.O., MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 235 PEACHTREE ST NE | ||||||||
| Address2: | SUITE 2100 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303031401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709949326 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 235 PEACHTREE ST NE | ||||||||
| Address2: | SUITE 2100 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303031401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709949326 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2007 | ||||||||
| LastUpdateDate: | 05/11/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 001967 | MI | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 1382 | SC | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 001967 | GA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | 67166 | GA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.