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1003366840
DERRICK SMITH
LEESBURG, GA
NPI
1003366840
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
171W00000X Contractor
(Licence: GA 17100000x)
Enumeration Date
2016-10-05
Last Update Date
2016-10-05
Business Address
-- DERRICK SMITH
100 MEDLEY DR
LEESBURG, GA 31763-3272
Phone number: 229-343-8849
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Mailing Address
-- DERRICK SMITH
100 MEDLEY DR
LEESBURG, GA 31763-3272
Phone number:
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