MEDICARE: BETTY ANN SMITH FNP-C

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	363LF0000X	Family Nurse Practitioner	RN089891	GA

General Provider Information

NPI Number	:	1326583360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETTY ANN SMITH FNP-C

Provider Business Mailing Address
First Line	:	905 N LIBERTY ST
Second Line	:
City	:	NICHOLLS
State	:	GA
Zip	:	31554-4016
Country	:	US
Telephone Number	:	912-921-3772
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 N BARTOW ST
Second Line	:
City	:	NASHVILLE
State	:	GA
Zip	:	31639-1435
Country	:	US
Telephone Number	:	229-686-2774
Fax Number	:	229-543-1348

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

Provider Enumeration Date	:	12/29/2016
Last Update Date	:	11/12/2019

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