Healthcare Provider Details

I. General information

NPI: 1033038633
Provider Name (Legal Business Name): KEELI DONYAE SMITH MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 MLK DR
MACON MS
39341-2734
US

IV. Provider business mailing address

43 MLK DR
MACON MS
39341-2734
US

V. Phone/Fax

Practice location:
  • Phone: 662-726-5042
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: