Healthcare Provider Details

I. General information

NPI: 1447164868
Provider Name (Legal Business Name): KIANA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3527 RIVER WATCH PKWY
MARTINEZ GA
30907-2919
US

IV. Provider business mailing address

902 CALUMET CT
GROVETOWN GA
30813-3814
US

V. Phone/Fax

Practice location:
  • Phone: 706-210-0091
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH036540
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: