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General NPI Number Information
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NPI Number | 1316043227
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Entity Type | Individual
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Provider Name | AMANDA S SMITH PA
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Gender | Female
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 12/26/2023
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Provider Practice Location Address
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Address Line | 700 RIVERSIDE AVE
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City | WAYCROSS
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State | GA
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Zip | 31501-5358
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Country | US
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Telephone | 912-490-8546
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Fax | 877-221-0052
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Provider Business Mailing Address
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Address Line | 700 RIVERSIDE AVE
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City | WAYCROSS
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State | GA
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Zip | 31501-5358
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Country | US
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Telephone | 912-490-8546
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Fax | 877-221-0052
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9103832
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License Number State | FL
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