Healthcare Provider Details

I. General information

NPI: 1063345346
Provider Name (Legal Business Name): RANDI E SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 15TH ST
AUGUSTA GA
30901-2607
US

IV. Provider business mailing address

905 15TH ST
AUGUSTA GA
30901-2607
US

V. Phone/Fax

Practice location:
  • Phone: 762-375-3074
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License Number230443
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: