Healthcare Provider Details

I. General information

NPI: 1225907827
Provider Name (Legal Business Name): JACINTA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 11/03/2025
Certification Date: 11/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 WINDY HILL RD SE
MARIETTA GA
30067-8478
US

IV. Provider business mailing address

3000 WINDY HILL RD SE
MARIETTA GA
30067-8478
US

V. Phone/Fax

Practice location:
  • Phone: 404-936-1470
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: