Healthcare Provider Details

I. General information

NPI: 1518885557
Provider Name (Legal Business Name): HEATHER RENEE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR DR SE
ATLANTA GA
30303-3031
US

IV. Provider business mailing address

1850 COTILLION DR UNIT 1105
DUNWOODY GA
30338-7885
US

V. Phone/Fax

Practice location:
  • Phone: 209-226-5109
  • Fax:
Mailing address:
  • Phone: 209-226-5109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN322032
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: