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NPI Code Detail

MEDICARE: JULIE MONTGOMERY SMITH PA

MEDICARE: JULIE MONTGOMERY SMITH PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant6493GA
2363AM0700XMedical Physician Assistant006493GA

General Provider Information

NPI Number : 1407119753
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIE MONTGOMERY SMITH PA
Provider Business Mailing Address
First Line : PO BOX 742616
Second Line :
City : ATLANTA
State : GA
Zip : 30374-2616
Country : US
Telephone Number : 770-219-8420
Fax Number :
Provider Business Practice Location Address
First Line : 4919 ATLANTA HWY
Second Line :
City : FLOWERY BRANCH
State : GA
Zip : 30542-3328
Country : US
Telephone Number : 770-965-9222
Fax Number : 770-965-8811
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2012
Last Update Date : 01/22/2021

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Directions to “ JULIE MONTGOMERY SMITH PA” Practice Location

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