Healthcare Provider Details

I. General information

NPI: 1831676691
Provider Name (Legal Business Name): RACHEL SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 05/26/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10916 SERENBE LN
CHATTAHOOCHEE HILLS GA
30268-2496
US

IV. Provider business mailing address

10916 SERENBE LANE, PALMETTO, GA, USA
PALMETTO GA
30268-3516
US

V. Phone/Fax

Practice location:
  • Phone: 404-960-6142
  • Fax:
Mailing address:
  • Phone: 140-496-0614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHADS000991
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: