Individual
KAITLYN SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
343 SALEM GATE DR SE STE 100, CONYERS, GA 30013-1783
(770) 285-3533
(770) 502-6052
Mailing address
343 SALEM GATE DR SE STE 100, CONYERS, GA 30013-1783
(770) 285-3533
(770) 502-6052
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
9190
GA
363AM0700X
Medical Physician Assistant
Primary
9190
GA
Other
Enumeration date
03/11/2019
Last updated
07/28/2020
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