Provider Demographics
NPI:1124613393
Name:SMITH, CAITLYN HOPE (NP)
Entity type:Individual
Prefix:MRS
First Name:CAITLYN
Middle Name:HOPE
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:CAITLYN
Other - Middle Name:HOPE
Other - Last Name:HUFFSCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:51 GORDON RD STE 201
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-7104
Mailing Address - Country:US
Mailing Address - Phone:706-692-9768
Mailing Address - Fax:706-692-4040
Practice Address - Street 1:3755 SIXES RD STE 300
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-7848
Practice Address - Country:US
Practice Address - Phone:706-692-9768
Practice Address - Fax:706-692-4040
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA274894363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
RN274894OtherLICENSE