# MR. MASON WILLIAMS SMITH

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1588662506
- **Gender:** Man
- **Credential:** P.A.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 183500000X | Pharmacist | RPH011423 | GA | — |
| 363A00000X | Physician Assistant | 000305 | GA | Yes |

## Other

- **Enumeration date:** 07/13/2005
- **Last updated:** 11/18/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100001353A | — | GA |
| 01 | — | 10047407 | AMERIGROUP | GA |