Provider Demographics
NPI:1285384529
Name:SMITH, JAYLUN IAN (MD)
Entity type:Individual
Prefix:
First Name:JAYLUN
Middle Name:IAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 STONEBRIDGE BLVD APT 1123
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-4675
Mailing Address - Country:US
Mailing Address - Phone:770-833-6597
Mailing Address - Fax:
Practice Address - Street 1:9 ARBOR SPRINGS TER STE 500
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-4214
Practice Address - Country:US
Practice Address - Phone:770-400-7270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA103701207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine