Provider Demographics
NPI:1619397916
Name:SMITH, ANITA T (MED, CHES)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:T
Last Name:SMITH
Suffix:
Gender:F
Credentials:MED, CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6725 MOON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-3246
Mailing Address - Country:US
Mailing Address - Phone:706-507-3150
Mailing Address - Fax:706-507-3150
Practice Address - Street 1:6725 MOON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-3246
Practice Address - Country:US
Practice Address - Phone:706-507-3150
Practice Address - Fax:706-507-3150
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA21678174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator