Provider Demographics
NPI:1568865830
Name:KIMBERLY SMILEY, PSY.D., LLC
Entity Type:Organization
Organization Name:KIMBERLY SMILEY, PSY.D., LLC
Other - Org Name:KIMBERLY SMILEY, PSY.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMILEY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:770-953-4744
Mailing Address - Street 1:1827 POWERS FERRY ROAD, BUILDING 22
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339
Mailing Address - Country:US
Mailing Address - Phone:770-953-4744
Mailing Address - Fax:770-953-4640
Practice Address - Street 1:1827 POWERS FERRY ROAD, BUILDING 22
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339
Practice Address - Country:US
Practice Address - Phone:770-953-4744
Practice Address - Fax:770-953-4640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002828103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA501804875AMedicaid
GA68BBGSWMedicare PIN