Individual
JACOB BASTON SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
705 DIXIE ST, CARROLLTON, GA 30117-3818
(770) 836-9597
Mailing address
607 VALLEY RUN DR, BREMEN, GA 30110-2413
(678) 836-3697
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
GA
Other
Enumeration date
05/04/2026
Last updated
05/04/2026
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