1851640114 NPI number — MRS. ELIZZIEBETH C SMITH APRN, FNP-BC

Table of content: MRS. ELIZZIEBETH C SMITH APRN, FNP-BC (NPI 1851640114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851640114 NPI number — MRS. ELIZZIEBETH C SMITH APRN, FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
ELIZZIEBETH
Provider Middle Name:
C
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN, FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JENNINGS
Provider Other First Name:
ELIZZIEBETH
Provider Other Middle Name:
CATHARINE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1851640114
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3035 SIERRA RIDGE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOGANVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30052-8603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-518-3838
Provider Business Mailing Address Fax Number:
770-483-7285

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2720 LOGANVILLE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOGANVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30052-7715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-277-5996
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/02/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  RN183843 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com