MEDICARE: MILLICENT ALICIA 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	390200000X	Student in an Organized Health Care Education/Training Program		GA

General Provider Information

NPI Number	:	1770430118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILLICENT ALICIA SMITH

Provider Business Mailing Address
First Line	:	7065 BROWN DR S
Second Line	:
City	:	FAIRBURN
State	:	GA
Zip	:	30213-3189
Country	:	US
Telephone Number	:	404-748-8900
Fax Number	:

Provider Business Practice Location Address
First Line	:	7065 BROWN DR S
Second Line	:
City	:	FAIRBURN
State	:	GA
Zip	:	30213-3189
Country	:	US
Telephone Number	:	404-748-8900
Fax Number	:

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

Provider Enumeration Date	:	03/13/2026
Last Update Date	:	03/13/2026

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Directions to “ MILLICENT ALICIA SMITH ” Practice Location

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