Provider Demographics
NPI:1003298035
Name:SMITH, NATACHA
Entity type:Individual
Prefix:
First Name:NATACHA
Middle Name:
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 1:4864 JIMMY CARTER BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-3704
Mailing Address - Country:US
Mailing Address - Phone:770-676-5763
Mailing Address - Fax:770-676-5723
Practice Address - Street 1:4864 JIMMY CARTER BLVD STE 205
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-3704
Practice Address - Country:US
Practice Address - Phone:770-676-5763
Practice Address - Fax:770-676-5723
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-26
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9402723363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health