Healthcare Provider Details

I. General information

NPI: 1215246434
Provider Name (Legal Business Name): BETTY SMITH-WELDON DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BETTY SMITH DC

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2088 IDLEWOOD RD STE 6
TUCKER GA
30084-6264
US

IV. Provider business mailing address

2088 IDLEWOOD RD STE 6
TUCKER GA
30084-6264
US

V. Phone/Fax

Practice location:
  • Phone: 404-551-7516
  • Fax: 800-266-1446
Mailing address:
  • Phone: 45-517-5164
  • Fax: 800-266-1446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCHIR008595
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR008595
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: