Provider Demographics
NPI:1942739768
Name:SMITH, JOHN MARSHALL II
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MARSHALL
Last Name:SMITH
Suffix:II
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 1:1707 WATSON BLVD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-3606
Mailing Address - Country:US
Mailing Address - Phone:478-929-8030
Mailing Address - Fax:478-929-8095
Practice Address - Street 1:1707 WATSON BLVD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3606
Practice Address - Country:US
Practice Address - Phone:478-929-8030
Practice Address - Fax:478-929-8095
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN198334363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily