Provider Demographics
NPI:1083886923
Name:SMART, JOELLE MARIE (LMT, NMT)
Entity Type:Individual
Prefix:
First Name:JOELLE
Middle Name:MARIE
Last Name:SMART
Suffix:
Gender:F
Credentials:LMT, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 BLUE RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-5363
Mailing Address - Country:US
Mailing Address - Phone:706-835-1665
Mailing Address - Fax:
Practice Address - Street 1:426 BLUE RIDGE ST
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-5363
Practice Address - Country:US
Practice Address - Phone:706-835-1665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT004481225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist