Provider Demographics
NPI:1346843646
Name:SMITH, ALLYSON MEREDITH
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:MEREDITH
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 1:410 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:WRENS
Mailing Address - State:GA
Mailing Address - Zip Code:30833-1052
Mailing Address - Country:US
Mailing Address - Phone:404-202-8365
Mailing Address - Fax:
Practice Address - Street 1:536 GRAND SLAM DR
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-8044
Practice Address - Country:US
Practice Address - Phone:706-854-8434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET003242235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist