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General NPI Number Information
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NPI Number | 1396063368
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Entity Type | Individual
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Provider Name | NICOLE SMITH NP
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Gender | Female
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Dates
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Enumeration Date | 05/14/2010
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 840 PROFESSIONAL CENTER DR
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City | EASTMAN
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State | GA
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Zip | 31023-6734
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Country | US
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Telephone | 478-374-7801
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Fax |
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Provider Business Mailing Address
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Address Line | 840 PROFESSIONAL CENTER DR
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City | EASTMAN
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State | GA
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Zip | 31023-6734
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Country | US
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Telephone | 478-374-7801
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Fax | 478-374-7878
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN-NP156452
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License Number State | GA
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