MEDICARE: MS. WILSONIA LEE 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	101YM0800X	Mental Health Counselor	CSW002598	GA

General Provider Information

NPI Number	:	1255299947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. WILSONIA LEE SMITH

Provider Business Mailing Address
First Line	:	5256 ADAGIO LN
Second Line	:
City	:	LAKELAND
State	:	TN
Zip	:	38002-6009
Country	:	US
Telephone Number	:	901-603-1909
Fax Number	:

Provider Business Practice Location Address
First Line	:	715 PEACHTREE ST NE STE 100&200
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-2177
Country	:	US
Telephone Number	:	646-941-7645
Fax Number	:

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

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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