Provider Demographics
NPI:1578035457
Name:SMITH, GLORIA IRIS (BSCN, MN, NP-C)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:IRIS
Last Name:SMITH
Suffix:
Gender:F
Credentials:BSCN, MN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 HOSPITAL DR STE 210
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-8026
Mailing Address - Country:US
Mailing Address - Phone:478-787-6255
Mailing Address - Fax:
Practice Address - Street 1:310 HOSPITAL DR STE 210
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-8026
Practice Address - Country:US
Practice Address - Phone:478-787-6255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN281687363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily