Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 000836 | GA |
Y | 222Z00000X | Podiatrist | 000836 | GA |
N | 213EP1101X | Primary Podiatric Medicine | 000836 | GA |
N | 213ES0103X | Foot & Ankle Surgery | 000836 | GA |
NPI | 1457494239 |
---|---|
Provider Name | Dr. Jason Bradford Smaha |
First Address | Macon, GA 31208-4711 |
Second Address | Macon, GA 31201-1169 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 05/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U70780 | (02) | GA |