Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DN014501 | GA |
NPI | 1043577331 |
---|---|
Provider Name | Dr. Ashley Earldaniel Smith |
First Address | Augusta, GA 30912-0004 |
Second Address | Marietta, GA 30064-1670 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2012 |
Last Update Date | 27/02/2015 |