Provider Demographics
NPI:1881228914
Name:SMITH, ANNETTE (AAB,)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:AAB,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 HIGH MEADOW TRL
Mailing Address - Street 2:
Mailing Address - City:JENKINSBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30234-2028
Mailing Address - Country:US
Mailing Address - Phone:678-233-8081
Mailing Address - Fax:
Practice Address - Street 1:117 HIGH MEADOW TRL
Practice Address - Street 2:
Practice Address - City:JENKINSBURG
Practice Address - State:GA
Practice Address - Zip Code:30234-2028
Practice Address - Country:US
Practice Address - Phone:678-233-8081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No101Y00000XBehavioral Health & Social Service ProvidersCounselor