Healthcare Provider Details

I. General information

NPI: 1568865830
Provider Name (Legal Business Name): KIMBERLY SMILEY, PSY.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1827 POWERS FERRY ROAD, BUILDING 22
ATLANTA GA
30339
US

IV. Provider business mailing address

1827 POWERS FERRY ROAD, BUILDING 22
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: KIMBERLY SMILEY
Title or Position: PSYCHOLOGIST/OWNER
Credential: PSY.D.
Phone: 770-953-4744