Provider Demographics
NPI:1851817894
Name:SMITH, SHEILA ELOISE (MEDICAL ASSISTANT)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:ELOISE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8491 CEDAR CREEK RDG
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-4558
Mailing Address - Country:US
Mailing Address - Phone:678-201-9543
Mailing Address - Fax:
Practice Address - Street 1:8491 CEDAR CREEK RDG
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-4558
Practice Address - Country:US
Practice Address - Phone:678-201-9543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-22
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101Y00000X, 101YP2500X, 104100000X, 1041C0700X, 132700000X, 133NN1002X, 146D00000X, 172A00000X, 174H00000X, 183700000X, 376J00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No132700000XDietary & Nutritional Service ProvidersDietary Manager
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No172A00000XOther Service ProvidersDriver
No174H00000XOther Service ProvidersHealth Educator
No183700000XPharmacy Service ProvidersPharmacy Technician
No376J00000XNursing Service Related ProvidersHomemaker