Provider Demographics
NPI:1396317491
Name:SMITH, TONYA NATASHA (CNA, CMA)
Entity type:Individual
Prefix:MS
First Name:TONYA
Middle Name:NATASHA
Last Name:SMITH
Suffix:
Gender:F
Credentials:CNA, CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 TURKEY ROOST LANE
Mailing Address - Street 2:
Mailing Address - City:SHILOH
Mailing Address - State:GA
Mailing Address - Zip Code:31826
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:341 TURKEY ROOST LANE
Practice Address - Street 2:
Practice Address - City:SHILOH
Practice Address - State:GA
Practice Address - Zip Code:31826
Practice Address - Country:US
Practice Address - Phone:706-587-8090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0028871810376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide