Provider Demographics
NPI:1942827381
Name:SMART, COURTNEY SHANAE
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:SHANAE
Last Name:SMART
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 1:124 HERITAGE WAY
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-9650
Mailing Address - Country:US
Mailing Address - Phone:912-650-1662
Mailing Address - Fax:
Practice Address - Street 1:124 HERITAGE WAY
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-9650
Practice Address - Country:US
Practice Address - Phone:912-650-1662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2020-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN00300037941376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide