MEDICARE: JANET CAMPBELL SMITH MN MPH

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	363LF0000X	Family Nurse Practitioner	R057008	GA

General Provider Information

NPI Number	:	1407054935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET CAMPBELL SMITH MN MPH

Provider Business Mailing Address
First Line	:	5237 HAYDEN FARMS DR
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-4917
Country	:	US
Telephone Number	:	770-943-0525
Fax Number	:	770-943-0525

Provider Business Practice Location Address
First Line	:	5237 HAYDEN FARMS DR
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-4917
Country	:	US
Telephone Number	:	770-943-0525
Fax Number	:	770-943-0525

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

Provider Enumeration Date	:	07/05/2007
Last Update Date	:	07/08/2007

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