MEDICARE: MS. CARLA SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0400X	Case Management Registered Nurse	RN086726	GA

General Provider Information

NPI Number	:	1144668823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARLA SMITH

Provider Business Mailing Address
First Line	:	6537 W FAYETTEVILLE RD
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30296-2522
Country	:	US
Telephone Number	:	404-408-8040
Fax Number	:

Provider Business Practice Location Address
First Line	:	6537 W FAYETTEVILLE RD
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30296-2522
Country	:	US
Telephone Number	:	404-408-8040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2013
Last Update Date	:	06/04/2013

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Directions to “ MS. CARLA SMITH ” Practice Location

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