Son of Joel Perry Smith, Sr., MD and Ellen Janet "June" Goforth Smith. He graduated from Druid Hills High School in 1953, where he was a multi-sport athlete and set tri-state (GA/AL/FL) track records, successfully competing in sprints, hurdles and pole vaulting. He completed his undergraduate course work at Mercer University in 1956 and graduated from the Medical College of Georgia in 1960. He completed residencies in general surgery and otolaryngology at Bowman Gray School of Medicine, Wake Forest University. While working in the hospital ER, he met a nurse, Carolyn Williams, who he married in 1965 in Pinehurst, NC. He entered the U.S. Air Force as Captain and Chief of the Department of Otolaryngology at the U.S. Strategic Air Command, MacDill AFB, in Tampa, FL. He and his wife moved to Atlanta in 1967 and he began a private medical/surgical practice as a board-certified otolaryngologist and maxillofacial surgeon. His father, was an EENT doctor and they partnered in the practice. He held medical staff privileges and cared for patients at Georgia Baptist Hospital, Piedmont Hospital, Egleston Hospital, West Paces Ferry Hospital, Metropolitan Hospital and Emory University Midtown (Crawford Long Hospital). He was a founding member of the Georgia Society of Otolaryngology.

He served in leadership positions at several Atlanta hospitals, which included appointments in leadership roles as Chief of Surgery, Chairman of the Medical Staff and as an officer of his hospital's Board of Governors. He became a principal founder of a new physician-owned hospital named Doctors Memorial Hospital (later becoming part of Emory University Midtown). Following the acquisition of the Life of Georgia insurance building – a midtown Atlanta fixture since 1930 – it was converted it into a state-of-the-art hospital at the corner of West Peachtree Street and Linden Avenue. He performed cutting-edge research in the emerging ENT specialty, creating new surgical procedures and developing early advancements for minimally invasive endoscopic procedures, laser utilization and microsurgery. He was published in NIH sponsored research on cranial nerves. He also published research findings in numerous publications related to orbital fractures, neck injuries, hearing loss and diseases affecting the head and neck. Although he participated in many advancements in his field and was exceptionally trained, he was remembered as the "Praying Doctor," because he prayed for every patient before surgery. Upon his retirement, the Georgia Society of Otolaryngology recognized him with the Lester Brown Lifetime Achievement Award.

He served for many years as a member/officer on the Board of the Metropolitan Atlanta Crime Commission, and was recognized by the mayor of Atlanta as a citizen leader. He developed a course related to the pathophysiology of stress on law enforcement officers and taught cadet classes at the Atlanta Police Academy for many years. Additionally, he served as a Major in the Georgia State Defense Force for Homeland Security. Returning to his early days as a competitive runner, he continued to run in 10K and half marathons. He enjoyed competing with professional and law enforcement marksmen and was designated among the elite ranks of the state's top sharpshooters in Georgia's 'Governor's Twenty' competition. He and his wife were members of Church of the Apostles for over 30 years. He was preceded in death by his parents Joel, Sr. and June; and brother, Michael. He is survived by his wife of 56 years, Carolyn Williams Smith; children, Joel Smith, III (Shae), Preston Smith (Liz), Elizabeth Carroll (Kells); thirteen grandchildren, Joel IV, Taylor, Hunter, Preston, Jr., Christi, Jordan, Marshall, Abigail, Lydia, Brayden, Carson, David and Grace; and sisters, Lynda Carter and Ellen Marks.