Provider Demographics
NPI:1366313884
Name:SMITH, DALLAS JAMES
Entity type:Individual
Prefix:
First Name:DALLAS
Middle Name:JAMES
Last Name:SMITH
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 MARKET ST STE B
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30021-2652
Mailing Address - Country:US
Mailing Address - Phone:678-383-1383
Mailing Address - Fax:
Practice Address - Street 1:3700 MARKET ST STE B
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:GA
Practice Address - Zip Code:30021-2652
Practice Address - Country:US
Practice Address - Phone:678-383-1383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH033326183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist