Provider Demographics
NPI:1467276543
Name:SMITH-GRAHAM, LISABETH MARIE (RN, MSN, CNM)
Entity type:Individual
Prefix:
First Name:LISABETH
Middle Name:MARIE
Last Name:SMITH-GRAHAM
Suffix:
Gender:F
Credentials:RN, MSN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 ROSWELL FARMS DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-4367
Mailing Address - Country:US
Mailing Address - Phone:404-578-9047
Mailing Address - Fax:
Practice Address - Street 1:135 ROSWELL FARMS DR
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-4367
Practice Address - Country:US
Practice Address - Phone:404-578-9047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN138229163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse