Provider Demographics
NPI:1346587094
Name:SMITH, TINA M (RPH)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 HAL JONES RD
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-3338
Mailing Address - Country:US
Mailing Address - Phone:770-328-7731
Mailing Address - Fax:
Practice Address - Street 1:100 GLENDA TRCE
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-3863
Practice Address - Country:US
Practice Address - Phone:770-502-8665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018249183500000X
FLPS37576183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist