MEDICARE: LORI MELLEN 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	231H00000X	Audiologist	AUD003491	GA

General Provider Information

NPI Number	:	1447287016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI MELLEN SMITH

Provider Business Mailing Address
First Line	:	6022 SANDY SPRINGS CIR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-3832
Country	:	US
Telephone Number	:	404-256-5194
Fax Number	:	404-256-5151

Provider Business Practice Location Address
First Line	:	6022 SANDY SPRINGS CIR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-3832
Country	:	US
Telephone Number	:	404-256-5194
Fax Number	:	404-256-5151

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

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	07/08/2007

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Directions to “ LORI MELLEN SMITH ” Practice Location

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