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General NPI Number Information
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NPI Number | 1972925709
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Entity Type | Individual
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Provider Name | JAWAUNA SMITH PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/14/2014
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Last Update Date | 01/14/2014
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Provider Practice Location Address
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Address Line | 4343 SHALLOWFORD RD STE B4A
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City | MARIETTA
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State | GA
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Zip | 30062-5003
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Country | US
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Telephone | 770-992-0002
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Fax |
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Provider Business Mailing Address
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Address Line | 8208 WESLEY PROVIDENCE PKWY
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City | LITHONIA
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State | GA
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Zip | 30038-6966
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Country | US
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Telephone | 678-939-9051
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Fax |
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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 | 006455
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License Number State | GA
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