Provider Demographics
NPI:1588698880
Name:SMITH, MARIA A (NP)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:119 AMBULANCE DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3857
Mailing Address - Country:US
Mailing Address - Phone:770-836-9326
Mailing Address - Fax:770-836-9358
Practice Address - Street 1:705 DIXIE ST
Practice Address - Street 2:SUITE 401
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3818
Practice Address - Country:US
Practice Address - Phone:770-836-9326
Practice Address - Fax:770-836-9358
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2014-07-14
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Provider Licenses
StateLicense IDTaxonomies
GARN107296363LA2100X, 364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA306726231CMedicaid
GA306726231GMedicaid