Provider Demographics
NPI:1104216720
Name:SMITH, JENNIFER HAIR
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HAIR
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 GI MADDOX PKWY
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30705-3222
Mailing Address - Country:US
Mailing Address - Phone:706-517-5006
Mailing Address - Fax:706-695-0424
Practice Address - Street 1:502 GI MADDOX PKWY
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:GA
Practice Address - Zip Code:30705-3222
Practice Address - Country:US
Practice Address - Phone:706-517-5006
Practice Address - Fax:706-695-0424
Is Sole Proprietor?:No
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH019269183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist