Healthcare Provider Details

I. General information

NPI: 1912833492
Provider Name (Legal Business Name): KYRA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 CORPORATE CENTER DR STE C
STOCKBRIDGE GA
30281-7376
US

IV. Provider business mailing address

255 CORPORATE CENTER DR STE C
STOCKBRIDGE GA
30281-7376
US

V. Phone/Fax

Practice location:
  • Phone: 678-982-4483
  • Fax:
Mailing address:
  • Phone: 678-982-4483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT002381
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: