Provider Demographics
NPI:1376879825
Name:SMITH, JUSTIN R (PA-C)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:R
Last Name:SMITH
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:605 S ENOTA DR NE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-2437
Mailing Address - Country:US
Mailing Address - Phone:770-538-0208
Mailing Address - Fax:770-538-0556
Practice Address - Street 1:605 S ENOTA DR NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2437
Practice Address - Country:US
Practice Address - Phone:770-538-0208
Practice Address - Fax:770-538-0556
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2011-06-20
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Provider Licenses
StateLicense IDTaxonomies
GA005694363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical