MEDICARE: ALEXIS 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	111N00000X	Chiropractor	CHIR009596	GA

General Provider Information

NPI Number	:	1922470350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS SMITH

Provider Business Mailing Address
First Line	:	1927 HIGHWAY 138 NE STE 500
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30013-1254
Country	:	US
Telephone Number	:	770-860-8333
Fax Number	:	770-860-8833

Provider Business Practice Location Address
First Line	:	1927 HIGHWAY 138 NE STE 500
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30013-1254
Country	:	US
Telephone Number	:	770-860-8333
Fax Number	:	770-860-8833

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

Provider Enumeration Date	:	10/26/2015
Last Update Date	:	10/26/2015

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Directions to “ ALEXIS SMITH ” Practice Location

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