Provider Demographics
NPI:1790071363
Name:SMITH, REBECCA MADDOX (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:MADDOX
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:MADDOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1905 SCENIC HWY N
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-5633
Mailing Address - Country:US
Mailing Address - Phone:678-344-8223
Mailing Address - Fax:678-344-8223
Practice Address - Street 1:1905 SCENIC HWY N
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-5633
Practice Address - Country:US
Practice Address - Phone:678-344-8223
Practice Address - Fax:678-344-8223
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH024316183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist