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General NPI Number Information
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NPI Number | 1962472506
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Entity Type | Individual
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Provider Name | MARY BETH SMARRA PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/25/2006
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Last Update Date | 04/21/2017
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Provider Practice Location Address
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Address Line | 605 N WESTOVER BLVD
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City | ALBANY
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State | GA
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Zip | 31707-2188
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Country | US
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Telephone | 520-625-6600
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Fax | 520-625-8467
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Provider Business Mailing Address
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Address Line | 605 N WESTOVER BLVD
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City | ALBANY
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State | GA
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Zip | 31707-2188
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Country | US
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Telephone | 520-625-6600
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Fax | 520-625-8467
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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 | MA003457L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 3714
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 7797
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License Number State | GA
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