MEDICARE: JASON HENRY SMITH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	057188	GA

General Provider Information

NPI Number	:	1417997909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON HENRY SMITH M.D.

Provider Business Mailing Address
First Line	:	900 CAIRO RD
Second Line	:
City	:	THOMASVILLE
State	:	GA
Zip	:	31792-4255
Country	:	US
Telephone Number	:	229-227-5158
Fax Number	:	229-227-5187

Provider Business Practice Location Address
First Line	:	259 US HIGHWAY 19 N
Second Line	:
City	:	CAMILLA
State	:	GA
Zip	:	31730-1410
Country	:	US
Telephone Number	:	229-336-1949
Fax Number	:	229-336-1436

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	06/25/2015

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