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General NPI Number Information
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NPI Number | 1194916700
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Entity Type | Individual
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Provider Name | GLORIA V. SMIKLE CPNP
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Gender | Female
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 08/08/2007
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Provider Practice Location Address
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Address Line | 35 JESSE HILL JR DR SE
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City | ATLANTA
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State | GA
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Zip | 30303-3032
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Country | US
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Telephone | 404-785-9777
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Fax | 404-778-1467
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Provider Business Mailing Address
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Address Line | 49 JESSE HILL JR DR SE
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City | ATLANTA
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State | GA
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Zip | 30303-3049
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Country | US
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Telephone | 404-778-1458
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Fax | 404-778-1467
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | RN060906
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License Number State | GA
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