MEDICARE: LA'RIKA VONYEA 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	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1922895622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LA'RIKA VONYEA SMITH

Provider Business Mailing Address
First Line	:	5 CARTERET PL
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30032-2382
Country	:	US
Telephone Number	:	404-862-6815
Fax Number	:	404-286-1670

Provider Business Practice Location Address
First Line	:	4045 FIVE FORKS TRICKUM RD SW
Second Line	:	SUITE BP9 #8051
City	:	LILBURN
State	:	GA
Zip	:	30047
Country	:	US
Telephone Number	:	404-862-2815
Fax Number	:	404-286-1670

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

Provider Enumeration Date	:	04/24/2025
Last Update Date	:	01/11/2026

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Directions to “ LA'RIKA VONYEA SMITH ” Practice Location

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