MEDICARE: BRIDGETTE SMART

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	202138	GA

General Provider Information

NPI Number	:	1962938548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGETTE SMART

Provider Business Mailing Address
First Line	:	2919 HERRON LN SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-1501
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2919 HERRON LN SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-1501
Country	:	US
Telephone Number	:	404-343-3988
Fax Number	:

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

Provider Enumeration Date	:	05/03/2017
Last Update Date	:	05/03/2017

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Directions to “ BRIDGETTE SMART ” Practice Location

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