Provider Demographics
NPI:1932425220
Name:KILEE RAYELLE SMITH, DO, PC
Entity Type:Organization
Organization Name:KILEE RAYELLE SMITH, DO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAMARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:706-896-4673
Mailing Address - Street 1:103 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:HIAWASSEE
Mailing Address - State:GA
Mailing Address - Zip Code:30546-3223
Mailing Address - Country:US
Mailing Address - Phone:706-896-4673
Mailing Address - Fax:706-896-3992
Practice Address - Street 1:103 CHURCH ST
Practice Address - Street 2:
Practice Address - City:HIAWASSEE
Practice Address - State:GA
Practice Address - Zip Code:30546-3223
Practice Address - Country:US
Practice Address - Phone:706-896-4673
Practice Address - Fax:706-896-3992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA63815207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty