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NPI Code Detail

MEDICARE: MS. GWENDOLYN WILLIAMS SMITH APRN,BC

MEDICARE: MS. GWENDOLYN WILLIAMS SMITH APRN,BC
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
1363LW0102XWomen's Health Nurse PractitionerRN075901GA

General Provider Information

NPI Number : 1558490417
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. GWENDOLYN WILLIAMS SMITH APRN,BC
Provider Business Mailing Address
First Line : 2126 FAIRCREST AVE
Second Line :
City : AUGUSTA
State : GA
Zip : 30906-9439
Country : US
Telephone Number : 706-798-5565
Fax Number :
Provider Business Practice Location Address
First Line : 2420 WINDSOR SPRING RD
Second Line :
City : AUGUSTA
State : GA
Zip : 30906-4668
Country : US
Telephone Number : 706-790-0661
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2007
Last Update Date : 07/19/2007

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