Healthcare Provider Details

I. General information

NPI: 1639203961
Provider Name (Legal Business Name): DEBBIE KAY SMITH PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 VILLAGE VIEW DR
GAINESVILLE GA
30506-4331
US

IV. Provider business mailing address

6130 BACK BAY CIR
FLOWERY BRANCH GA
30542-5330
US

V. Phone/Fax

Practice location:
  • Phone: 678-450-3050
  • Fax:
Mailing address:
  • Phone: 678-938-3668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License NumberPTA001604
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA001604
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: