Basic Information
Provider Information
NPI: 1003017468
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SMITH
FirstName: RYAN
MiddleName: THOMAS
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1330 INTERSTATE PKWY
Address2:  
City: AUGUSTA
State: GA
PostalCode: 309095625
CountryCode: US
TelephoneNumber: 7066512020
FaxNumber: 7068556674
Practice Location
Address1: 1330 INTERSTATE PKWY
Address2:  
City: AUGUSTA
State: GA
PostalCode: 309095625
CountryCode: US
TelephoneNumber: 7066512020
FaxNumber: 7068556674
Other Information
ProviderEnumerationDate: 05/31/2007
LastUpdateDate: 05/28/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207W00000X66645GAY Allopathic & Osteopathic PhysiciansOphthalmology 
207W00000X57009416OHN Allopathic & Osteopathic PhysiciansOphthalmology 

ID Information
IDTypeStateIssuerDescription
202I18371201GAPTANOTHER
296526005OH MEDICAID
P0074892901OHRAILROAD MEDICAREOTHER
P0072574501KYRAILROAD MEDICAREOTHER


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