Healthcare Provider Details

I. General information

NPI: 1588279749
Provider Name (Legal Business Name): DANA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 COURTENAY DR NE
ATLANTA GA
30306-3421
US

IV. Provider business mailing address

789 BARNETT ST NE APT 3
ATLANTA GA
30306-4179
US

V. Phone/Fax

Practice location:
  • Phone: 404-875-4551
  • Fax:
Mailing address:
  • Phone: 678-699-7698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMSW009269
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: