Provider Demographics
NPI:1700378197
Name:SMITH MORETZ, TONYA MICHELLE (NP-C)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:MICHELLE
Last Name:SMITH MORETZ
Suffix:
Gender:F
Credentials: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:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:705-334-7867
Practice Address - Street 1:23 TIPTON DR
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-1603
Practice Address - Country:US
Practice Address - Phone:706-867-6505
Practice Address - Fax:706-867-0135
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN230288363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily