Provider Demographics
NPI:1578942439
Name:SMITH, EMILIA III
Entity Type:Individual
Prefix:
First Name:EMILIA
Middle Name:
Last Name:SMITH
Suffix:III
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 1:1811 MOUNT PISGAH LN
Mailing Address - Street 2:23
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-2154
Mailing Address - Country:US
Mailing Address - Phone:240-701-6344
Mailing Address - Fax:
Practice Address - Street 1:6856 EASTERN AVENUE
Practice Address - Street 2:358
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012
Practice Address - Country:US
Practice Address - Phone:202-621-7329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11307374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide