Healthcare Provider Details

I. General information

NPI: 1699259408
Provider Name (Legal Business Name): NEIKA T. SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3461 FAIRWAY DR
COLLEGE PARK GA
30337-1624
US

IV. Provider business mailing address

2440 FREEMONT ST
SNELLVILLE GA
30078-3381
US

V. Phone/Fax

Practice location:
  • Phone: 323-875-6498
  • Fax:
Mailing address:
  • Phone: 323-875-6498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberRN281327
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-154031
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: