Provider Demographics
NPI:1093816704
Name:SMART, ADAM (CSA)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:
Last Name:SMART
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:MR
Other - First Name:ADAM
Other - Middle Name:
Other - Last Name:SMART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CSA
Mailing Address - Street 1:245 N HIGHLAND AVE
Mailing Address - Street 2:230-451
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307
Mailing Address - Country:US
Mailing Address - Phone:404-935-2189
Mailing Address - Fax:888-265-5564
Practice Address - Street 1:245 N HIGHLAND AVE
Practice Address - Street 2:230-451
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-1936
Practice Address - Country:US
Practice Address - Phone:404-935-2189
Practice Address - Fax:888-265-5564
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2627363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty