Provider Demographics
NPI:1689248262
Name:SMITH, DONNA
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
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 1:3096 S HORNER BLVD STE 278
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-9644
Mailing Address - Country:US
Mailing Address - Phone:678-637-1080
Mailing Address - Fax:
Practice Address - Street 1:3096 S HORNER BLVD # 278
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332-9644
Practice Address - Country:US
Practice Address - Phone:678-637-1080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health