Provider Demographics
NPI:1386187268
Name:SMITH, MARY W (HADS)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:W
Last Name:SMITH
Suffix:
Gender:F
Credentials:HADS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 GLEN EAGLE CT
Mailing Address - Street 2:SUITE 10B
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-4267
Mailing Address - Country:US
Mailing Address - Phone:678-796-0060
Mailing Address - Fax:
Practice Address - Street 1:200 GLEN EAGLE CT
Practice Address - Street 2:SUITE 10B
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4267
Practice Address - Country:US
Practice Address - Phone:678-796-0060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHAD000940237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist