Provider Demographics
NPI:1558835181
Name:SMITH, JAMES AUSTIN JR
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:AUSTIN
Last Name:SMITH
Suffix:JR
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 1:7100 NEW KENSINGTON CT
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20187-8901
Mailing Address - Country:US
Mailing Address - Phone:571-383-1121
Mailing Address - Fax:
Practice Address - Street 1:7100 NEW KENSINGTON CT
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20187-8901
Practice Address - Country:US
Practice Address - Phone:571-383-1121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-16
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA174200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174200000XOther Service ProvidersMeals