Individual
MRS. LISA M SMITH
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
107 MAIN ST, PLAINS, GA 31780-5570
(229) 824-7757
(229) 824-3497
Mailing address
PO BOX 196, PLAINS, GA 31780-0196
(229) 824-3438
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
002904
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002904
LICENSE
GA
Enumeration date
10/19/2005
Last updated
07/08/2007
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