Provider Demographics
NPI:1962886945
Name:SMITH, TASIA (DC)
Entity type:Individual
Prefix:DR
First Name:TASIA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 COBB PKWY N APT 6201
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-9204
Mailing Address - Country:US
Mailing Address - Phone:270-366-1639
Mailing Address - Fax:
Practice Address - Street 1:923 DILL AVE SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-4145
Practice Address - Country:US
Practice Address - Phone:404-753-3141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-19
Last Update Date:2015-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009551111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor