MEDICARE: ELLEN JEANETTE SMEAD CNM

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	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	APRN-CNM209228	GA
2	367A00000X	Advanced Practice Midwife

General Provider Information

NPI Number	:	1588939151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN JEANETTE SMEAD CNM

Provider Business Mailing Address
First Line	:	980 JOHNSON FERRY RD STE 660
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1608
Country	:	US
Telephone Number	:	404-497-1350
Fax Number	:	404-497-1427

Provider Business Practice Location Address
First Line	:	980 JOHNSON FERRY RD STE 660
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1608
Country	:	US
Telephone Number	:	404-497-1350
Fax Number	:	404-497-1427

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

Provider Enumeration Date	:	03/15/2012
Last Update Date	:	01/20/2026

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