Healthcare Provider Details

I. General information

NPI: 1689638124
Provider Name (Legal Business Name): LYNNE D SMITH F.N.P.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 NORMAN DORMINY DR STE A
FITZGERALD GA
31750-9069
US

IV. Provider business mailing address

PO BOX 749
OCILLA GA
31774-0749
US

V. Phone/Fax

Practice location:
  • Phone: 229-423-5437
  • Fax: 229-424-0868
Mailing address:
  • Phone: 229-468-9166
  • Fax: 229-468-9188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN60915
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: