Provider Demographics
NPI:1639769979
Name:SMITH, CHRISTY NICOLE (NNP)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:NICOLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:
Other - Last Name:RANDALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:42 ACROPOLIS CT
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-6158
Mailing Address - Country:US
Mailing Address - Phone:678-876-9696
Mailing Address - Fax:
Practice Address - Street 1:42 ACROPOLIS CT
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-6158
Practice Address - Country:US
Practice Address - Phone:678-876-9696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN267693363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care