Healthcare Provider Details

I. General information

NPI: 1336944818
Provider Name (Legal Business Name): BRIANNA SMITH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 GENERAL BOOTH BLVD
VIRGINIA BEACH VA
23454-5691
US

IV. Provider business mailing address

2675 PACES FERRY RD SE STE 200
ATLANTA GA
30339-4099
US

V. Phone/Fax

Practice location:
  • Phone: 757-721-0512
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMS0195132
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number13096
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: