Provider Demographics
NPI:1386497261
Name:SMITH, JANICE MARIA
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:MARIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:SMITH
Other - Last Name:RN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1217 LAKEVIEW XING
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-2753
Mailing Address - Country:US
Mailing Address - Phone:337-210-6456
Mailing Address - Fax:
Practice Address - Street 1:1217 LAKEVIEW XING
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30088-2753
Practice Address - Country:US
Practice Address - Phone:337-210-6456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA309359163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse