Provider Demographics
NPI:1750862298
Name:SMITH, JOYCE VICTORIA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:VICTORIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:JOYCE
Other - Middle Name:VICTORIA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:207 MELODY LN
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-5019
Mailing Address - Country:US
Mailing Address - Phone:423-453-0193
Mailing Address - Fax:
Practice Address - Street 1:6110 SHALLOWFORD RD STE B
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1894
Practice Address - Country:US
Practice Address - Phone:423-499-1031
Practice Address - Fax:423-296-6384
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN69963164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN164X00000XMedicaid