MEDICARE: CECELIA L SMITH N.P.

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	363LA2200X	Adult Health Nurse Practitioner	71001194	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962588657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CECELIA L SMITH N.P.

Provider Business Mailing Address
First Line	:	PO BOX 746720
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6720
Country	:	US
Telephone Number	:	312-733-9730
Fax Number	:	773-866-8014

Provider Business Practice Location Address
First Line	:	2240 E 53RD ST # B1
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-3479
Country	:	US
Telephone Number	:	317-933-7047
Fax Number	:	317-667-1574

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

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	04/22/2021

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