Healthcare Provider Details

I. General information

NPI: 1548834641
Provider Name (Legal Business Name): B. SMITH & ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2021
Last Update Date: 05/14/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 RUSSELL PKWY STE 36
WARNER ROBINS GA
31088-8681
US

IV. Provider business mailing address

PO BOX 6916
WARNER ROBINS GA
31095-6916
US

V. Phone/Fax

Practice location:
  • Phone: 478-333-1232
  • Fax: 478-333-1368
Mailing address:
  • Phone: 478-333-1232
  • Fax: 478-333-1368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: MRS. BARBARA A SMITH
Title or Position: CEO
Credential: M.ED.
Phone: 478-352-1025