Healthcare Provider Details

I. General information

NPI: 1598168973
Provider Name (Legal Business Name): MS. TERRI SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2014
Last Update Date: 09/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 DAYVIEW LN
ATLANTA GA
30331-9514
US

IV. Provider business mailing address

2655 DAYVIEW LN
ATLANTA GA
30331-9514
US

V. Phone/Fax

Practice location:
  • Phone: 678-923-5292
  • Fax:
Mailing address:
  • Phone: 678-923-5292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT000599
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: