Healthcare Provider Details

I. General information

NPI: 1033203476
Provider Name (Legal Business Name): KIMBERLY SMILEY PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1827 POWERS FERRY RD., BLDG. 22, STE. 200 BLDG. 22, STE. 200
ATLANTA GA
30339
US

IV. Provider business mailing address

1827 POWERS FERRY RD., BLDG. 22, STE. 200 BLDG. 22, STE. 200
ATLANTA GA
30339
US

V. Phone/Fax

Practice location:
  • Phone: 770-953-4744
  • Fax: 770-953-4640
Mailing address:
  • Phone: 770-953-4744
  • Fax: 770-953-4640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY002828
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: