Healthcare Provider Details

I. General information

NPI: 1194797852
Provider Name (Legal Business Name): CHRISTA DAWN SMITH NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

396 HISTORIC HIGHWAY 441 N
DEMOREST GA
30535-4522
US

IV. Provider business mailing address

PO BOX 459
COLBERT GA
30628-0459
US

V. Phone/Fax

Practice location:
  • Phone: 706-754-4348
  • Fax: 706-754-0731
Mailing address:
  • Phone: 706-788-3234
  • Fax: 706-788-2936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN129289
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: