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General NPI Number Information
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NPI Number | 1023814688
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Entity Type | Organization
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Legal Business Name | TL SMITH HEALTHCARE LLC
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Dates
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Enumeration Date | 02/24/2025
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 3190 TACKETT RD
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-9104
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Country | US
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Telephone | 706-564-6605
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Fax |
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Provider Business Mailing Address
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Address Line | 3190 TACKETT RD
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-9104
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Country | US
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Telephone | 706-564-6605
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Fax |
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Authorized Official
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Title or Position | CEO/DIRECTOR
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Name | MS. TAUKEISHA SMITH
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Credential | RN
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Telephone | 706-564-6605
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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