Provider Demographics
NPI:1952464166
Name:SMITH, ARDELLA LENORA (EISC)
Entity Type:Individual
Prefix:MISS
First Name:ARDELLA
Middle Name:LENORA
Last Name:SMITH
Suffix:
Gender:F
Credentials:EISC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 PLAINVILLE DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-4322
Mailing Address - Country:US
Mailing Address - Phone:404-472-0680
Mailing Address - Fax:
Practice Address - Street 1:470 PLAINVILLE DR SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-4322
Practice Address - Country:US
Practice Address - Phone:404-472-0680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator