Healthcare Provider Details

I. General information

NPI: 1568765774
Provider Name (Legal Business Name): REBECCA SMITH POWELL N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA NICOLE SMITH

II. Dates (important events)

Enumeration Date: 12/09/2010
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 SHRINE RD STE 290
BRUNSWICK GA
31520-4785
US

IV. Provider business mailing address

2500 STARLING ST STE 404
BRUNSWICK GA
31520-4269
US

V. Phone/Fax

Practice location:
  • Phone: 912-466-7660
  • Fax: 912-264-1526
Mailing address:
  • Phone: 912-466-7660
  • Fax: 912-264-1526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN-NP256397
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: