Individual
JULIA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2745 LOGANVILLE HWY, LOGANVILLE, GA 30052
(470) 655-2364
Mailing address
30 SWEET CANE CT, GRAYSON, GA 30017-4041
(678) 779-1598
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
8778
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1142284
NCCPA CERTIFICATION ID
NC
Enumeration date
05/07/2018
Last updated
06/25/2019
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