Provider Demographics
NPI:1467803007
Name:SMITH, GEORGIA NICOLE
Entity Type:Individual
Prefix:MRS
First Name:GEORGIA
Middle Name:NICOLE
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 1:303 SAN EMIDIO CT
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-6138
Mailing Address - Country:US
Mailing Address - Phone:559-836-0324
Mailing Address - Fax:559-585-1192
Practice Address - Street 1:303 SAN EMIDIO CT
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-6138
Practice Address - Country:US
Practice Address - Phone:559-836-0324
Practice Address - Fax:559-585-1192
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)