Provider Demographics
NPI:1134644107
Name:SMITH, RHONDA JEAN (LPN)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:JEAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:RHONDA
Other - Middle Name:JEAN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:1449 TEMPLE RD
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:GA
Mailing Address - Zip Code:30110-2378
Mailing Address - Country:US
Mailing Address - Phone:770-534-2367
Mailing Address - Fax:770-537-1203
Practice Address - Street 1:1449 TEMPLE RD
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:GA
Practice Address - Zip Code:30110-2378
Practice Address - Country:US
Practice Address - Phone:770-534-2367
Practice Address - Fax:770-537-1203
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN09729164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse