Provider Demographics
NPI:1528713625
Name:SMITH, MAGGIE C (FNP-C)
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:C
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:C
Other - Last Name:KELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1495 HICKORY FLAT HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-4267
Mailing Address - Country:US
Mailing Address - Phone:678-505-4455
Mailing Address - Fax:
Practice Address - Street 1:1495 HICKORY FLAT HWY STE 200
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-4267
Practice Address - Country:US
Practice Address - Phone:678-505-4455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-16
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN297742363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily