Individual
MR. JOHN ISAAC SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
1765 OLD WEST BROAD ST, ATHENS, GA 30606-2853
(706) 549-1663
(706) 546-8792
Mailing address
1765 OLD WEST BROAD ST BLDG 2-200, ATHENS, GA 30606-2887
(706) 549-1663
(706) 546-8792
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT015433
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15173787
CAQH NUMBER
—
Enumeration date
05/18/2021
Last updated
03/11/2024
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