Healthcare Provider Details

I. General information

NPI: 1245913532
Provider Name (Legal Business Name): ERIN MICHELLE SMITH NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2023
Last Update Date: 08/11/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 DIXIE ST STE 350
CARROLLTON GA
30117-3860
US

IV. Provider business mailing address

706 DIXIE ST STE 350
CARROLLTON GA
30117-3860
US

V. Phone/Fax

Practice location:
  • Phone: 770-812-5831
  • Fax:
Mailing address:
  • Phone: 770-812-5831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRN209301
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: