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General NPI Number Information
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NPI Number | 1487139184
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Entity Type | Individual
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Provider Name | LORRAINE A SMITH FNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/27/2018
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Last Update Date | 09/27/2018
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Provider Practice Location Address
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Address Line | 3121 GRUNDY IVES DR
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City | SNELLVILLE
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State | GA
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Zip | 30039-3610
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Country | US
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Telephone | 678-507-4688
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Fax | 678-639-3333
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Provider Business Mailing Address
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Address Line | 3121 GRUNDY IVES DR
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City | SNELLVILLE
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State | GA
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Zip | 30039-3610
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Country | US
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Telephone | 678-507-4688
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Fax | 678-639-3333
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | F09180144
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License Number State | GA
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