Provider Demographics
NPI:1225324635
Name:SMITH, MONICA MONE' (DPT)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:MONE'
Last Name:SMITH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4877 BILL GARDNER PKWY
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-3644
Mailing Address - Country:US
Mailing Address - Phone:404-367-2097
Mailing Address - Fax:678-304-1396
Practice Address - Street 1:4877 BILL GARDNER PKWY
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-3644
Practice Address - Country:US
Practice Address - Phone:404-367-2097
Practice Address - Fax:678-304-1396
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010385225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist