MEDICARE: MRS. JEANNA LYNN SMITH NURSE PRACTITIONER

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	363LA2200X	Adult Health Nurse Practitioner	APRN-NP152964	GA
2	363LF0000X	Family Nurse Practitioner	RN152964	GA
3	363LF0000X	Family Nurse Practitioner	21117	SC

General Provider Information

NPI Number	:	1649789041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JEANNA LYNN SMITH NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	PO BOX 689022
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37068-9022
Country	:	US
Telephone Number	:	615-465-7211
Fax Number	:	615-628-6877

Provider Business Practice Location Address
First Line	:	1497 FAIR RD STE 206
Second Line	:
City	:	STATESBORO
State	:	GA
Zip	:	30458-0824
Country	:	US
Telephone Number	:	912-486-1121
Fax Number	:

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

Provider Enumeration Date	:	09/28/2017
Last Update Date	:	02/09/2026

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