Individual
MR. HULET SMITH JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.T.
Contact information
Practice address
1367 SYDNEYS PASS, WATKINSVILLE, GA 30677-8393
(770) 725-9186
(603) 843-2144
Mailing address
1367 SYDNEYS PASS, WATKINSVILLE, GA 30677-8393
(770) 725-9186
(603) 843-2144
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT002264
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000823237A
—
GA
01
—
10040248
AMERIGROUP PROVIDER NUM
GA
01
—
342037
WELLCARE PROVIDER NUMBER
GA
Enumeration date
11/21/2006
Last updated
11/30/2010
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