MEDICARE: KAYSHA 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	101Y00000X	Counselor	053719213	GA

General Provider Information

NPI Number	:	1477495596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYSHA SMITH

Provider Business Mailing Address
First Line	:	407 KINGSWOOD DR
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31707-5809
Country	:	US
Telephone Number	:	229-594-7189
Fax Number	:

Provider Business Practice Location Address
First Line	:	407 KINGSWOOD DR
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31707-5809
Country	:	US
Telephone Number	:	229-594-7189
Fax Number	:

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

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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Directions to “ KAYSHA SMITH ” Practice Location

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