Healthcare Provider Details

I. General information

NPI: 1538081153
Provider Name (Legal Business Name): JADORI A SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5641 HILLANDALE DR
LITHONIA GA
30058
US

IV. Provider business mailing address

5850 HILLANDALE DR
LITHONIA GA
30058-4927
US

V. Phone/Fax

Practice location:
  • Phone: 470-361-2976
  • Fax:
Mailing address:
  • Phone: 678-886-2223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-516612
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: