Provider Demographics
NPI:1811486244
Name:SMITH, LASASSHA ALEXANDRIA (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:LASASSHA
Middle Name:ALEXANDRIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:LASASSHA
Other - Middle Name:ALEXANDRIA
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:260 ELM ST
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2467
Mailing Address - Country:US
Mailing Address - Phone:470-758-8573
Mailing Address - Fax:
Practice Address - Street 1:475 TRIBBLE GAP RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2478
Practice Address - Country:US
Practice Address - Phone:470-758-8573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN285857363LW0102X
SC223275163W00000X
GA285857363L00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty