Healthcare Provider Details

I. General information

NPI: 1710222328
Provider Name (Legal Business Name): JENNIFER SCHOLZ SMITH PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2012
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 FELTON PL SUITE A
CARTERSVILLE GA
30120-2153
US

IV. Provider business mailing address

17 FELTON PL SUITE A
CARTERSVILLE GA
30120-2153
US

V. Phone/Fax

Practice location:
  • Phone: 770-386-8996
  • Fax: 770-386-8100
Mailing address:
  • Phone: 770-386-8996
  • Fax: 770-386-8100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3629
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: