MEDICARE: SAVANNAH BRADY SMITH PA-C

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
1	363A00000X	Physician Assistant	11106	GA

General Provider Information

NPI Number	:	1871226118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAVANNAH BRADY SMITH PA-C

Provider Business Mailing Address
First Line	:	3051 WATSON BLVD
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31093-8536
Country	:	US
Telephone Number	:	478-953-4563
Fax Number	:

Provider Business Practice Location Address
First Line	:	3051 WATSON BLVD
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31093-8536
Country	:	US
Telephone Number	:	478-953-4563
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2022
Last Update Date	:	04/10/2026

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