MEDICARE: MS. CORDIA YVETTE SMITH LCSW

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	CSW003968	GA

General Provider Information

NPI Number	:	1972735314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CORDIA YVETTE SMITH LCSW

Provider Business Mailing Address
First Line	:	300 VILLAGE GREEN CIR SE
Second Line	:	SUITE 201
City	:	SMYRNA
State	:	GA
Zip	:	30080-3476
Country	:	US
Telephone Number	:	678-469-3947
Fax Number	:	770-438-6172

Provider Business Practice Location Address
First Line	:	300 VILLAGE GREEN CIR SE
Second Line	:	SUITE 201
City	:	SMYRNA
State	:	GA
Zip	:	30080-3476
Country	:	US
Telephone Number	:	678-469-3947
Fax Number	:	770-438-6172

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

Provider Enumeration Date	:	08/19/2009
Last Update Date	:	08/19/2009

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