=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437023090
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VANDI ELISE SMITH CSA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2025
-----------------------------------------------------
Last Update Date | 10/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2151 W SPRING ST
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30655-3202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-267-8461
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4145 LINKS BLVD
-----------------------------------------------------
City | JEFFERSON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30549-8831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-749-9694
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246ZC0007X
-----------------------------------------------------
Taxonomy Name | Surgical Assistant
-----------------------------------------------------
License Number | 0136000220
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------