Individual
AMANDA S SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
700 RIVERSIDE AVE, WAYCROSS, GA 31501-5358
(912) 490-8546
(877) 221-0052
Mailing address
700 RIVERSIDE AVE, WAYCROSS, GA 31501-5358
(912) 490-8546
(877) 221-0052
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9103832
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003130352C
—
GA
05
—
292817500
—
FL
Enumeration date
09/16/2006
Last updated
12/26/2023
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