Provider Demographics
NPI:1952621674
Name:SMITH, TERESITA MARIA (PHD, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:TERESITA
Middle Name:MARIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 NORTHLAKE DR
Mailing Address - Street 2:
Mailing Address - City:KEYSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30816-4316
Mailing Address - Country:US
Mailing Address - Phone:706-231-0400
Mailing Address - Fax:912-829-5335
Practice Address - Street 1:626 OLD RIVER RD
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:GA
Practice Address - Zip Code:30467-3315
Practice Address - Country:US
Practice Address - Phone:912-829-5300
Practice Address - Fax:912-829-5335
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN043558 NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily