Provider Demographics
NPI:1376822858
Name:SMITH, SHARLENE
Entity Type:Individual
Prefix:MRS
First Name:SHARLENE
Middle Name:
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 1:50 BLUE GRASS WAY
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30054
Mailing Address - Country:US
Mailing Address - Phone:678-625-0776
Mailing Address - Fax:678-625-0776
Practice Address - Street 1:50 BLUE GRASS WAY
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:GA
Practice Address - Zip Code:30054
Practice Address - Country:US
Practice Address - Phone:678-625-0776
Practice Address - Fax:678-625-0776
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GABLH-19018374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide