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NPI Code Detail

MEDICARE: CARYN J. MASTERMAN-SMITH D.O.

MEDICARE: CARYN J. MASTERMAN-SMITH D.O.
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
1208000000XPediatrics PhysicianOS8651FL
2208000000XPediatrics Physician63712GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598767857
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARYN J. MASTERMAN-SMITH D.O.
Provider Business Mailing Address
First Line : PO BOX 407
Second Line :
City : VIDALIA
State : GA
Zip : 30475-0407
Country : US
Telephone Number : 912-537-4986
Fax Number :
Provider Business Practice Location Address
First Line : 125 CHURCH ST
Second Line :
City : VIDALIA
State : GA
Zip : 30474-4770
Country : US
Telephone Number : 912-538-8484
Fax Number : 912-538-8665
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2005
Last Update Date : 02/10/2022

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