Provider Demographics
NPI:1922291871
Name:SMITH, GEORGIA
Entity Type:Individual
Prefix:MISS
First Name:GEORGIA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:GEORGIA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1238 W 39TH ST
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-2844
Mailing Address - Country:US
Mailing Address - Phone:440-960-1493
Mailing Address - Fax:
Practice Address - Street 1:1238 W 39TH ST
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-2844
Practice Address - Country:US
Practice Address - Phone:440-960-1493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.067056164W00000X
OHPN. 067056164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse