Healthcare Provider Details

I. General information

NPI: 1922895622
Provider Name (Legal Business Name): LA'RIKA VONYEA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2025
Last Update Date: 01/11/2026
Certification Date: 01/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4045 FIVE FORKS TRICKUM RD SW SUITE BP9 #8051
LILBURN GA
30047
US

IV. Provider business mailing address

5 CARTERET PL
DECATUR GA
30032-2382
US

V. Phone/Fax

Practice location:
  • Phone: 404-862-2815
  • Fax: 404-286-1670
Mailing address:
  • Phone: 404-862-6815
  • Fax: 404-286-1670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: