Provider Demographics
NPI:1356956098
Name:SMITH, ERICIA (CPB, CCS, AST)
Entity type:Individual
Prefix:
First Name:ERICIA
Middle Name:
Last Name:SMITH
Suffix:
Gender:
Credentials:CPB, CCS, AST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1246 MOOTY BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-1118
Mailing Address - Country:US
Mailing Address - Phone:706-550-9273
Mailing Address - Fax:888-927-8365
Practice Address - Street 1:1246 MOOTY BRIDGE RD
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-1118
Practice Address - Country:US
Practice Address - Phone:706-550-9273
Practice Address - Fax:888-927-8365
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA01978515246Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health InformationGroup - Single Specialty