Healthcare Provider Details

I. General information

NPI: 1679195341
Provider Name (Legal Business Name): WHITNEY ALICE SMITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2020
Last Update Date: 05/15/2020
Certification Date: 05/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4083 CLOUD SPRINGS RD
RINGGOLD GA
30736-8411
US

IV. Provider business mailing address

282 MISTY RIDGE LN
RINGGOLD GA
30736-2926
US

V. Phone/Fax

Practice location:
  • Phone: 800-805-6989
  • Fax:
Mailing address:
  • Phone: 423-582-9663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN286677
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: