Provider Demographics
NPI:1215448360
Name:SMITH, JOANNA GOYETTE (PA-C)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:GOYETTE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 PAUL MELLON CT STE 102
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2793
Mailing Address - Country:US
Mailing Address - Phone:301-645-7414
Mailing Address - Fax:301-645-7997
Practice Address - Street 1:102 PAUL MELLON CT STE 102
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2793
Practice Address - Country:US
Practice Address - Phone:215-503-5724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant