Provider Demographics
NPI:1720324189
Name:SMITH, ARTHUR W (BC-HIS)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:W
Last Name:SMITH
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11900 US HIGHWAY 280
Mailing Address - Street 2:
Mailing Address - City:ELLABELL
Mailing Address - State:GA
Mailing Address - Zip Code:31308-3603
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11900 US HIGHWAY 280
Practice Address - Street 2:
Practice Address - City:ELLABELL
Practice Address - State:GA
Practice Address - Zip Code:31308-3603
Practice Address - Country:US
Practice Address - Phone:912-507-7280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHADS000619237700000X
SCHAS-0379237700000X
FLAS 3334237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist