Provider Demographics
NPI:1922357789
Name:SMITH, CARYN DELICIA
Entity Type:Individual
Prefix:MS
First Name:CARYN
Middle Name:DELICIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2206 TARA LN
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-2752
Mailing Address - Country:US
Mailing Address - Phone:912-399-0239
Mailing Address - Fax:
Practice Address - Street 1:2206 TARA LN
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-2752
Practice Address - Country:US
Practice Address - Phone:912-399-0239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor