Healthcare Provider Details

I. General information

NPI: 1356811822
Provider Name (Legal Business Name): SMITHA GEORGY NP- BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 11/10/2022
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26129 W 6 MILE RD
REDFORD MI
48240-2218
US

IV. Provider business mailing address

48615 RED OAK DR
SHELBY TOWNSHIP MI
48315-4050
US

V. Phone/Fax

Practice location:
  • Phone: 313-543-3100
  • Fax:
Mailing address:
  • Phone: 248-835-7517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704251884
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704251884
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: