MEDICARE: ADRA FAITH SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	019821	GA

General Provider Information

NPI Number	:	1215115134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRA FAITH SMITH

Provider Business Mailing Address
First Line	:	285 SAGE ST
Second Line	:
City	:	TEMPLE
State	:	GA
Zip	:	30179-3846
Country	:	US
Telephone Number	:	770-562-3268
Fax Number	:	770-562-1414

Provider Business Practice Location Address
First Line	:	285 SAGE ST
Second Line	:
City	:	TEMPLE
State	:	GA
Zip	:	30179-3846
Country	:	US
Telephone Number	:	770-562-3268
Fax Number	:	770-562-1414

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2008
Last Update Date	:	02/01/2008

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Directions to “ ADRA FAITH SMITH ” Practice Location

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