Provider Demographics
NPI:1568172526
Name:SMITH, TASHAMMA LAKISHA
Entity Type:Individual
Prefix:MS
First Name:TASHAMMA
Middle Name:LAKISHA
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 1:3322 NEW BERN RIDGE DR APT 206
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1294
Mailing Address - Country:US
Mailing Address - Phone:919-648-3399
Mailing Address - Fax:
Practice Address - Street 1:3322 NEW BERN RIDGE DR APT 206
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1294
Practice Address - Country:US
Practice Address - Phone:919-648-3399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRDL-3007347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle