Healthcare Provider Details

I. General information

NPI: 1457494239
Provider Name (Legal Business Name): JASON BRADFORD SMAHA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 02/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1854 FORSYTH ST
MACON GA
31201-1169
US

IV. Provider business mailing address

PO BOX 4711
MACON GA
31208-4711
US

V. Phone/Fax

Practice location:
  • Phone: 478-745-2600
  • Fax: 478-742-5657
Mailing address:
  • Phone: 478-745-2600
  • Fax: 478-742-5657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number000836
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number000836
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000836
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: