Provider Demographics
NPI:1942495114
Name:SMITH, ANNETTE STACY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:STACY
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4083 CLOUD SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-8411
Mailing Address - Country:US
Mailing Address - Phone:805-896-9800
Mailing Address - Fax:851-155-8864
Practice Address - Street 1:700 CITY HALL DR
Practice Address - Street 2:
Practice Address - City:FT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-7802
Practice Address - Country:US
Practice Address - Phone:706-861-3387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN072212164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse