MEDICARE: TENISHA SMITH FNP

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	APRN-NP205077	GA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN-NP205077	GA

General Provider Information

NPI Number	:	1619475910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TENISHA SMITH FNP

Provider Business Mailing Address
First Line	:	445 GRAY WOLF DR
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31216-6983
Country	:	US
Telephone Number	:	478-787-4266
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 POPLAR ST
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31201-3336
Country	:	US
Telephone Number	:	478-787-4266
Fax Number	:

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

Provider Enumeration Date	:	02/01/2018
Last Update Date	:	05/19/2026

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