Provider Demographics
NPI:1457494239
Name:SMAHA, JASON BRADFORD (DPM)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:BRADFORD
Last Name:SMAHA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4711
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-4711
Mailing Address - Country:US
Mailing Address - Phone:478-745-2600
Mailing Address - Fax:478-742-5657
Practice Address - Street 1:1854 FORSYTH ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-1169
Practice Address - Country:US
Practice Address - Phone:478-745-2600
Practice Address - Fax:478-742-5657
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000836213E00000X, 213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU70780Medicare UPIN
GA48SCCDBMedicare Oscar/Certification
GA48SCCDBMedicare PIN