Provider Demographics
NPI:1194331975
Name:SMITH, LISA MARIE (DBA, PHIC, HC)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:DBA, PHIC, HC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3316A S COBB DR SE # 274
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-4118
Mailing Address - Country:US
Mailing Address - Phone:678-542-4997
Mailing Address - Fax:
Practice Address - Street 1:2470 WINDY HILL RD SE STE 300
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8621
Practice Address - Country:US
Practice Address - Phone:404-795-2082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth Educator
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No171W00000XOther Service ProvidersContractorGroup - Single Specialty
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No347E00000XTransportation ServicesTransportation Broker
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program