MEDICARE: CHRYSTAL JEAN SMITH L,C.S.W.

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	1041C0700X	Clinical Social Worker	CSW003123	GA
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1932263217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRYSTAL JEAN SMITH L,C.S.W.

Provider Business Mailing Address
First Line	:	1410 DOUBLE CHURCHES RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-2605
Country	:	US
Telephone Number	:	706-681-3278
Fax Number	:	706-321-9757

Provider Business Practice Location Address
First Line	:	1410 DOUBLE CHURCHES RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-2605
Country	:	US
Telephone Number	:	706-681-3278
Fax Number	:	706-321-9757

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	09/11/2025

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