Provider Demographics
NPI:1891036026
Name:SMITH, TIMOTHY GENE (LPN)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:GENE
Last Name:SMITH
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 MECHANICSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-0840
Mailing Address - Country:US
Mailing Address - Phone:706-867-2727
Mailing Address - Fax:706-867-2739
Practice Address - Street 1:60 MECHANICSVILLE RD
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-0840
Practice Address - Country:US
Practice Address - Phone:706-867-2727
Practice Address - Fax:706-867-2739
Is Sole Proprietor?:No
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA082287164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse