Provider Demographics
NPI:1922697937
Name:SMITH, DENIECE (NTP)
Entity Type:Individual
Prefix:
First Name:DENIECE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:NTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 SHELLBARK DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-1606
Mailing Address - Country:US
Mailing Address - Phone:678-481-7454
Mailing Address - Fax:
Practice Address - Street 1:132 SHELLBARK DR
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-1606
Practice Address - Country:US
Practice Address - Phone:678-481-7454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA170072163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse