Healthcare Provider Details

I. General information

NPI: 1255256251
Provider Name (Legal Business Name): PEYTON THOMAS SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 FAIRVIEW PARK DR
DUBLIN GA
31021-2501
US

IV. Provider business mailing address

101 FAIRVIEW PARK DR
DUBLIN GA
31021-2501
US

V. Phone/Fax

Practice location:
  • Phone: 478-272-7494
  • Fax:
Mailing address:
  • Phone: 478-272-7494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA003201
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: