Most Relevant Information
Provider Data
| NPI Number: | 1003366840 |
| Provider Name: | DERRICK SMITH |
| Entity Type: | Individual |
| Taxonomy Code: | 171W00000X |
| Specialty: | Contractor |
| License Number: | 17100000X |
Most Important Dates
| Enumeration Date: | 10/05/2016 |
| Last Updated: | 10/05/2016 |
Provider Practice Location
100 MEDLEY DR
LEESBURG
GA
317633272
Practice Location Phone/Fax
| Phone: | 2293438849 |
| Fax: |
Provider Mailing Location
100 MEDLEY DR
LEESBURG
GA
317633272
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |