Provider Demographics
NPI:1396509212
Name:SMITH, CHANTIONA NICHELE
Entity type:Individual
Prefix:MISS
First Name:CHANTIONA
Middle Name:NICHELE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8285 N STERLING LAKES DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-3762
Mailing Address - Country:US
Mailing Address - Phone:678-296-3333
Mailing Address - Fax:
Practice Address - Street 1:8285 N STERLING LAKES DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-3762
Practice Address - Country:US
Practice Address - Phone:678-296-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle