Individual
WALTER JASON SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1635 OLD 41 HWY NW, KENNESAW, GA 30152-4480
(870) 530-0081
Mailing address
1635 OLD 41 HWY NW, KENNESAW, GA 30152-4480
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN185136
GA
Other
Enumeration date
03/07/2016
Last updated
03/07/2016
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