Provider Demographics
NPI:1447922349
Name:SMITH, GABRIELLE ARYADNI (PA)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ARYADNI
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 LAVA LN
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-5188
Mailing Address - Country:US
Mailing Address - Phone:404-719-3099
Mailing Address - Fax:
Practice Address - Street 1:2300 CAMP CREEK PKWY
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30337-3304
Practice Address - Country:US
Practice Address - Phone:678-666-4088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical