Provider Demographics
NPI:1699586644
Name:SMITH, JOSEPH NATHANIEL (PA)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:NATHANIEL
Last Name:SMITH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 MEDICAL CENTER BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-7765
Mailing Address - Country:US
Mailing Address - Phone:404-845-8200
Mailing Address - Fax:
Practice Address - Street 1:2200 MEDICAL CENTER BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7765
Practice Address - Country:US
Practice Address - Phone:404-845-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-17
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12870363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant