Healthcare Provider Details

I. General information

NPI: 1962605535
Provider Name (Legal Business Name): ALISHA AIKENS SMITH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10704 POLLY TAYLOR RD
JOHNS CREEK GA
30097-1805
US

IV. Provider business mailing address

2281 FAIRFIELD AVE
STATHAM GA
30666-3380
US

V. Phone/Fax

Practice location:
  • Phone: 678-770-7649
  • Fax:
Mailing address:
  • Phone: 404-583-3551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN154813
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: