Healthcare Provider Details

I. General information

NPI: 1831065556
Provider Name (Legal Business Name): ROSA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2025
Last Update Date: 12/25/2025
Certification Date: 12/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3618 CAMERON DR
AUGUSTA GA
30906-4306
US

IV. Provider business mailing address

216 WILLIAMS ST
TROY NC
27371-3522
US

V. Phone/Fax

Practice location:
  • Phone: 706-294-1215
  • Fax:
Mailing address:
  • Phone: 706-294-1215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number556630
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number556630
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number556630
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: