Provider Demographics
NPI:1427231042
Name:SMITH TRANSITIONAL AND REHABILITATION SERVICES, INC.
Entity Type:Organization
Organization Name:SMITH TRANSITIONAL AND REHABILITATION SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLI
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:678-634-1826
Mailing Address - Street 1:184 NORTH AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-3291
Mailing Address - Country:US
Mailing Address - Phone:678-634-1826
Mailing Address - Fax:678-479-9300
Practice Address - Street 1:184 NORTH AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-3291
Practice Address - Country:US
Practice Address - Phone:678-634-1826
Practice Address - Fax:678-479-9300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039478874A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA039478874AMedicaid