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NPI Code Detail

MEDICARE: MARILYNN RAE SMITH-BOWLES NP

MEDICARE: MARILYNN RAE SMITH-BOWLES NP
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
1363LG0600XGerontology Nurse PractitionerAPRN-NP193197GA
2363L00000XNurse PractitionerRN193197GA

General Provider Information

NPI Number : 1740718154
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARILYNN RAE SMITH-BOWLES NP
Provider Business Mailing Address
First Line : 1255 HIGHWAY 54 W
Second Line :
City : FAYETTEVILLE
State : GA
Zip : 30214-4526
Country : US
Telephone Number : 770-716-0087
Fax Number :
Provider Business Practice Location Address
First Line : 1255 HIGHWAY 54 W
Second Line :
City : FAYETTEVILLE
State : GA
Zip : 30214-4526
Country : US
Telephone Number : 770-716-0087
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2017
Last Update Date : 03/12/2026

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