Provider Demographics
NPI:1194797852
Name:SMITH, CHRISTA DAWN (NP-C)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:DAWN
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:COLBERT
Mailing Address - State:GA
Mailing Address - Zip Code:30628-0459
Mailing Address - Country:US
Mailing Address - Phone:706-788-3234
Mailing Address - Fax:706-788-2936
Practice Address - Street 1:396 HISTORIC HIGHWAY 441 N
Practice Address - Street 2:
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535-4522
Practice Address - Country:US
Practice Address - Phone:706-754-4348
Practice Address - Fax:706-754-0731
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN129289363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA842111062CMedicaid
GA10045298OtherAMERIGROUP
GA335985OtherWELLCARE
GA10045298OtherAMERIGROUP