Individual
MR. SMART GUOBADIA
Active
Individual
MR. SMART GUOBADIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
067-R-1663
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003216332A
—
GA
05
—
003216332B
—
GA
Enumeration date
06/07/2019
Last updated
06/07/2019
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