Ivy Yvonne Smith, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

053075 Issued in GA

Practice address

120 Handley Rd
Ste 410
Tyrone, GA 30290-1625

Phone

(770) 964-5810

Fax

(678) 364-1216

NPI assigned

Sep 14, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Papp Clinic Laboratory

  • Clinical Medical Laboratory
  • Newnan, GA
  • NPI 1932353042
  NPD (past)
• Piedmont Medical Care Corporation

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1912956046

  Family Medicine

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216598400000",
    "number": "1801991773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 HANDLEY RD",
            "address_2": "STE 410",
            "city": "TYRONE",
            "state": "GA",
            "postal_code": "302901625",
            "telephone_number": "770-964-5810",
            "fax_number": "678-364-1216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 HANDLEY RD",
            "address_2": "STE 410",
            "city": "TYRONE",
            "state": "GA",
            "postal_code": "302901625",
            "telephone_number": "770-964-5810",
            "fax_number": "678-364-1216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "IVY",
        "middle_name": "YVONNE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-14",
        "last_updated": "2008-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "053075",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "407530212B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lindsey Feldman Shurack
• Sistah Space Women'S Wellness Center, LLC
• Matthew Skoner, OD
• Johannes Daniel Smit, RPH
• Brian A Smith, DMD,P.C
• Viva Lashawn Snowden, FNP-BC
• Sound Connection Speech LLC
• Southside ABA LLC
• Christa R. Springston, M.D.
• Jemeka Lashay Stallworth, LPC, MSCP, CPCS, NCC

• Family Medicine Physician in Tyrone, GA
• Providers in Tyrone, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.