Healthcare Provider Details

I. General information

NPI: 1033702600
Provider Name (Legal Business Name): MICAH PAULETTE SMITH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2021
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON RD NE
ATLANTA GA
30322-1059
US

IV. Provider business mailing address

245 E TRINITY PL UNIT 1446
DECATUR GA
30030-3494
US

V. Phone/Fax

Practice location:
  • Phone: 404-712-7109
  • Fax:
Mailing address:
  • Phone: 858-449-6629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SE0003X
TaxonomyEmergency Clinical Nurse Specialist
License NumberRN261603
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN261603
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: