Provider Demographics
NPI:1881603314
Name:SMITH, CAROLYN A (PA)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1365 CLIFTON RD NE
Mailing Address - Street 2:SUITE B2200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1013
Mailing Address - Country:US
Mailing Address - Phone:404-778-5770
Mailing Address - Fax:404-778-4472
Practice Address - Street 1:1365 CLIFTON RD NE
Practice Address - Street 2:SUITE B2200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1013
Practice Address - Country:US
Practice Address - Phone:404-778-5770
Practice Address - Fax:404-778-4472
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA002587363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA002587OtherPHYSICIAN ASSISTANT LICEN