Individual
MR. MASON WILLIAMS SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
131A VICTORY DR, SWAINSBORO, GA 30401-3234
(478) 237-8342
(478) 237-8281
Mailing address
302 BARFIELD DR, DUBLIN, GA 31021-0410
(478) 237-8342
(478) 237-8281
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
RPH011423
GA
363A00000X
Physician Assistant
Primary
000305
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100001353A
—
GA
01
—
10047407
AMERIGROUP
GA
Enumeration date
07/13/2005
Last updated
11/18/2022
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