Healthcare Provider Details

I. General information

NPI: 1124954532
Provider Name (Legal Business Name): STEPHEN J. SMITH PHYSICIAN ASSISTANT, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6651 MADISON AVE
CARMICHAEL CA
95608-0602
US

IV. Provider business mailing address

3335 WATT AVE STE B #199
SACRAMENTO CA
95821-3615
US

V. Phone/Fax

Practice location:
  • Phone: 916-903-7520
  • Fax:
Mailing address:
  • Phone: 423-762-2844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN SMITH
Title or Position: OWNER
Credential: PA-C
Phone: 423-762-2844