Provider Demographics
NPI:1396124426
Name:SMITH, MICHELE LYONS (ND)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:LYONS
Last Name:SMITH
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5206 N HELTON RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30187-1124
Mailing Address - Country:US
Mailing Address - Phone:404-405-3051
Mailing Address - Fax:
Practice Address - Street 1:5751 W STEWARTS MILL RD
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-2448
Practice Address - Country:US
Practice Address - Phone:770-544-9774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath