MEDICARE: JASON SMITH ARNP

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	363L00000X	Nurse Practitioner	AP60933179	WA
2	363LA2100X	Acute Care Nurse Practitioner	AP60933179	WA
3	363LC0200X	Critical Care Medicine Nurse Practitioner	RN214460	GA

Other Identifiers

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

General Provider Information

NPI Number	:	1962883249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON SMITH ARNP

Provider Business Mailing Address
First Line	:	1968 PEACHTREE RD NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-1285
Country	:	US
Telephone Number	:	404-367-3014
Fax Number	:

Provider Business Practice Location Address
First Line	:	1968 PEACHTREE RD NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-1285
Country	:	US
Telephone Number	:	404-367-3014
Fax Number	:

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

Provider Enumeration Date	:	06/12/2015
Last Update Date	:	05/13/2022

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