Healthcare Provider Details

I. General information

NPI: 1588662506
Provider Name (Legal Business Name): MASON WILLIAMS SMITH P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131A VICTORY DR
SWAINSBORO GA
30401-3234
US

IV. Provider business mailing address

302 BARFIELD DR
DUBLIN GA
31021-0410
US

V. Phone/Fax

Practice location:
  • Phone: 478-237-8342
  • Fax: 478-237-8281
Mailing address:
  • Phone: 478-237-8342
  • Fax: 478-237-8281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH011423
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number000305
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: