MEDICARE: LAKEASHA REBECCA 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	376J00000X	Homemaker		GA

General Provider Information

NPI Number	:	1215860804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKEASHA REBECCA SMITH

Provider Business Mailing Address
First Line	:	3700 BRIDGEWATER RD APT E2
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-6359
Country	:	US
Telephone Number	:	706-352-8308
Fax Number	:	706-352-8308

Provider Business Practice Location Address
First Line	:	3700 BRIDGEWATER RD APT E2
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-6359
Country	:	US
Telephone Number	:	706-352-8308
Fax Number	:	706-352-8308

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

Provider Enumeration Date	:	06/04/2026
Last Update Date	:	06/04/2026

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Directions to “ LAKEASHA REBECCA SMITH ” Practice Location

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