Healthcare Provider Details

I. General information

NPI: 1831035211
Provider Name (Legal Business Name): DENISE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DENISE ISSAH

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 EAGLES LANDING PKWY
STOCKBRIDGE GA
30281-5085
US

IV. Provider business mailing address

939 E LAKE DR APT 939
MARIETTA GA
30062-3830
US

V. Phone/Fax

Practice location:
  • Phone: 678-604-1000
  • Fax:
Mailing address:
  • Phone: 404-749-0144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: