Healthcare Provider Details

I. General information

NPI: 1427422435
Provider Name (Legal Business Name): JOYCE SMITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2015
Last Update Date: 11/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 LAWRENCEVILLE HWY SUITE 101
DECATUR GA
30033-3268
US

IV. Provider business mailing address

2450 LAWRENCEVILLE HWY SUITE 101
DECATUR GA
30033-3268
US

V. Phone/Fax

Practice location:
  • Phone: 770-609-6976
  • Fax: 404-601-9622
Mailing address:
  • Phone: 770-609-6976
  • Fax: 404-601-9622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number085858
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: