Individual
DONTAZ SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2136 HASEL ST, LAWRENCEVILLE, GA 30044-4525
(502) 210-9665
Mailing address
2136 HASEL ST, LAWRENCEVILLE, GA 30044-4525
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT002632
GA
Other
Enumeration date
07/09/2016
Last updated
07/09/2016
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