MEDICARE: MS. DONNA MARIE SMITH LCSW

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	104100000X	Social Worker	055332	NY
2	1041C0700X	Clinical Social Worker	CSW004837	GA

General Provider Information

NPI Number	:	1598736894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DONNA MARIE SMITH LCSW

Provider Business Mailing Address
First Line	:	302 PARC XING
Second Line	:
City	:	ACWORTH
State	:	GA
Zip	:	30102-1807
Country	:	US
Telephone Number	:	404-538-0823
Fax Number	:

Provider Business Practice Location Address
First Line	:	302 PARC XING
Second Line	:
City	:	ACWORTH
State	:	GA
Zip	:	30102-1807
Country	:	US
Telephone Number	:	404-538-0823
Fax Number	:

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

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	03/28/2018

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