Provider Demographics
NPI:1356811822
Name:GEORGY, SMITHA (NP- BC)
Entity type:Individual
Prefix:MRS
First Name:SMITHA
Middle Name:
Last Name:GEORGY
Suffix:
Gender:F
Credentials:NP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48615 RED OAK DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-4050
Mailing Address - Country:US
Mailing Address - Phone:248-835-7517
Mailing Address - Fax:
Practice Address - Street 1:26129 W 6 MILE RD
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48240-2218
Practice Address - Country:US
Practice Address - Phone:313-543-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704251884163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse