Provider Demographics
NPI:1841400082
Name:SMITH, SHLONDA BROWN
Entity Type:Individual
Prefix:MRS
First Name:SHLONDA
Middle Name:BROWN
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 1:98 BRANCH CT
Mailing Address - Street 2:
Mailing Address - City:BEECH ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29842-9475
Mailing Address - Country:US
Mailing Address - Phone:803-215-4532
Mailing Address - Fax:
Practice Address - Street 1:1928 KISSINGBOWER RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-5158
Practice Address - Country:US
Practice Address - Phone:803-215-4532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator