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NPI Code Detail

MEDICARE: MRS. ANNETTE STACY SMITH LPN

MEDICARE: MRS. ANNETTE STACY SMITH LPN
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
1164W00000XLicensed Practical NurseLPN072212GA

General Provider Information

NPI Number : 1942495114
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ANNETTE STACY SMITH LPN
Provider Business Mailing Address
First Line : 4083 CLOUD SPRINGS RD
Second Line :
City : RINGGOLD
State : GA
Zip : 30736-8411
Country : US
Telephone Number : 805-896-9800
Fax Number : 851-155-8864
Provider Business Practice Location Address
First Line : 700 CITY HALL DR
Second Line :
City : FT OGLETHORPE
State : GA
Zip : 30742-7802
Country : US
Telephone Number : 706-861-3387
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2007
Last Update Date : 10/26/2023

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