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General NPI Number Information
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NPI Number | 1083577076
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Entity Type | Individual
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Provider Name | MRS. TRISTA SMITH
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Gender | Female
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Dates
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Enumeration Date | 12/05/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 109 12TH ST # 271
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City | COLUMBUS
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State | GA
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Zip | 31901-5245
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Country | US
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Telephone | 912-734-2299
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Fax | 845-302-1687
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Provider Business Mailing Address
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Address Line | 332 NOTTINGHAM WAY
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City | HINESVILLE
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State | GA
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Zip | 31313-4467
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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