Provider Demographics
NPI:1003584806
Name:SMITH, AUSTIN DOUGLAS
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:DOUGLAS
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3023 SHINNECOCK HILLS DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-2045
Mailing Address - Country:US
Mailing Address - Phone:678-764-5824
Mailing Address - Fax:
Practice Address - Street 1:3023 SHINNECOCK HILLS DR
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-2045
Practice Address - Country:US
Practice Address - Phone:678-764-5824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-06
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant