| Doctor Name: | MR. HENRY WILDER SMITH, JR |
| NPI Number: | 1023012580 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA |
| License Number: | 000208 |
| Business Practice Address: | 114 S Jefferson St Swainsboro, GA - 304013146 |
| Business Phone Number: | 4782377517 |
| Business Fax Number: | 4782374299 |
| Mailing Address: | 210 N Racetrack St, SWAINSBORO |
| State: | GA |
| Postal Code: | 304013204 |
| Phone Number: | 4782378134 |
| Fax Number: | 4782374299 |
| NPI Enumeration Date: | 06/10/2005 |
| NPI Last Update Date: | 11/06/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 000208 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |