=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053713560
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIN MICHELLE SMITH FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2014
-----------------------------------------------------
Last Update Date | 05/30/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11702 MERCY BLVD STE 2G
-----------------------------------------------------
City | SAVANNAH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31419-1777
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-920-8898
-----------------------------------------------------
Fax | 912-920-4418
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 601 HART ST
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31329-4976
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-659-7460
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RN212021
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------