Provider Demographics
NPI:1588396329
Name:SMITH, HALIE LIN
Entity type:Individual
Prefix:
First Name:HALIE
Middle Name:LIN
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 1:4300 N POINT PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-4102
Mailing Address - Country:US
Mailing Address - Phone:770-442-1911
Mailing Address - Fax:
Practice Address - Street 1:3824 S HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:LA FAYETTE
Practice Address - State:GA
Practice Address - Zip Code:30728-3967
Practice Address - Country:US
Practice Address - Phone:706-639-9055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant