Provider Demographics
NPI:1306217013
Name:WEST-SMITH, SHARMELE (MASTECTOMY FITTER)
Entity Type:Individual
Prefix:
First Name:SHARMELE
Middle Name:
Last Name:WEST-SMITH
Suffix:
Gender:F
Credentials:MASTECTOMY FITTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4229 1ST AVE STE E
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4469
Mailing Address - Country:US
Mailing Address - Phone:678-515-7523
Mailing Address - Fax:
Practice Address - Street 1:4229 1ST AVE STE E
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4469
Practice Address - Country:US
Practice Address - Phone:678-515-7523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACO0986411744P3200X
GA224900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter
No1744P3200XOther Service ProvidersSpecialistProsthetics Case Management