Individual
MR. BRENTLY TED SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2416 CAPSTONE CT, COLUMBUS, GA 31909-2795
(706) 327-1281
(706) 576-9714
Mailing address
2416 CAPSTONE CT, COLUMBUS, GA 31909-2795
(706) 327-1281
(706) 576-9714
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
05052
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5052
GA. MEDICAL LICENSE
GA
Enumeration date
05/11/2007
Last updated
03/20/2020
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