Healthcare Provider Details

I. General information

NPI: 1467365361
Provider Name (Legal Business Name): JADE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 BROOKSTONE CENTRE PKWY
COLUMBUS GA
31904-9248
US

IV. Provider business mailing address

5817 SANDY RIDGE DR
COLUMBUS GA
31907-5340
US

V. Phone/Fax

Practice location:
  • Phone: 706-940-5677
  • Fax:
Mailing address:
  • Phone: 706-572-7117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC010753
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: