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General NPI Number Information
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NPI Number | 1912500109
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Entity Type | Individual
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Provider Name | CONNOR JAMESON SMITH PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/19/2020
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Last Update Date | 01/30/2023
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Provider Practice Location Address
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Address Line | 14534 OLD SAINT AUGUSTINE RD STE 3420
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City | JACKSONVILLE
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State | FL
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Zip | 32258-2645
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Country | US
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Telephone | 904-493-8001
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Fax | 904-388-0852
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Provider Business Mailing Address
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Address Line | PO BOX 746652
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City | ATLANTA
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State | GA
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Zip | 30374-6652
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Country | US
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Telephone | 47-200-5999
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Fax | 904-376-4036
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PAX000017679
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9113850
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License Number State | FL
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