Healthcare Provider Details

I. General information

NPI: 1356458954
Provider Name (Legal Business Name): KATHRYN A. SMITH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 02/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 S LEROY ST
METTER GA
30439-4631
US

IV. Provider business mailing address

215 N COLEMAN ST
SWAINSBORO GA
30401-3530
US

V. Phone/Fax

Practice location:
  • Phone: 912-685-4040
  • Fax: 912-685-4041
Mailing address:
  • Phone: 478-237-6262
  • Fax: 478-237-9138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN081837
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: