Provider Demographics
NPI:1376861823
Name:SMITH, NANCY WILLIS (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:WILLIS
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 PROMINENCE POINT PKWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-1236
Mailing Address - Country:US
Mailing Address - Phone:770-704-6988
Mailing Address - Fax:770-720-8775
Practice Address - Street 1:21 POINTE NORTH DR
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-7952
Practice Address - Country:US
Practice Address - Phone:678-721-0705
Practice Address - Fax:678-721-5116
Is Sole Proprietor?:No
Enumeration Date:2010-05-07
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN051699363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily