Provider Demographics
NPI:1710356845
Name:SMITH, ANSLEY
Entity Type:Individual
Prefix:
First Name:ANSLEY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MALL BLVD
Mailing Address - Street 2:SUITE T
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-4861
Mailing Address - Country:US
Mailing Address - Phone:912-355-7214
Mailing Address - Fax:
Practice Address - Street 1:459 HIGHWAY 119 S
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:GA
Practice Address - Zip Code:31329-3021
Practice Address - Country:US
Practice Address - Phone:912-754-0433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant