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General NPI Number Information
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NPI Number | 1659317675
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Entity Type | Individual
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Provider Name | CRYSTAL A SMITH CNP
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Gender | Female
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 05/17/2024
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Provider Practice Location Address
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Address Line | 2450 OLD MILTON PKWY STE 201
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City | ALPHARETTA
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State | GA
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Zip | 30009-2521
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Country | US
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Telephone | 470-267-0360
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Fax | 770-999-2691
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Provider Business Mailing Address
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Address Line | 2450 OLD MILTON PKWY STE 201
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City | ALPHARETTA
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State | GA
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Zip | 30009-2521
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Country | US
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Telephone | 470-267-0360
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Fax | 770-999-2691
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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 | 036068939
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN309424
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License Number State | GA
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