Provider Demographics
NPI:1851640114
Name:SMITH, ELIZZIEBETH C (APRN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ELIZZIEBETH
Middle Name:C
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:MISS
Other - First Name:ELIZZIEBETH
Other - Middle Name:CATHARINE
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3035 SIERRA RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-8603
Mailing Address - Country:US
Mailing Address - Phone:404-518-3838
Mailing Address - Fax:770-483-7285
Practice Address - Street 1:2720 LOGANVILLE HWY
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-7715
Practice Address - Country:US
Practice Address - Phone:770-277-5996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-02
Last Update Date:2012-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN183843363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily