Healthcare Provider Details

I. General information

NPI: 1538099882
Provider Name (Legal Business Name): COLLETTE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 BRAIDWOOD DR NW
ACWORTH GA
30101-3527
US

IV. Provider business mailing address

633 BRAIDWOOD DR NW
ACWORTH GA
30101-3527
US

V. Phone/Fax

Practice location:
  • Phone: 678-536-8737
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: