Healthcare Provider Details

I. General information

NPI: 1780799221
Provider Name (Legal Business Name): OWEN BRYAN SMITH PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FREEDOM WAY
AUGUSTA GA
30904-6258
US

IV. Provider business mailing address

2552 WILLOW CREEK CT
EVANS GA
30809-7433
US

V. Phone/Fax

Practice location:
  • Phone: 706-823-2235
  • Fax: 706-823-3968
Mailing address:
  • Phone: 706-823-2235
  • Fax: 706-823-3968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number014368
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: