Provider Demographics
NPI:1447616461
Name:SMITH, FARAH (NP-C)
Entity type:Individual
Prefix:
First Name:FARAH
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:654 CLETUS NOLAN RD
Mailing Address - Street 2:
Mailing Address - City:WILLACOOCHEE
Mailing Address - State:GA
Mailing Address - Zip Code:31650-3546
Mailing Address - Country:US
Mailing Address - Phone:912-393-4517
Mailing Address - Fax:
Practice Address - Street 1:300 SHIRLEY AVE
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2332
Practice Address - Country:US
Practice Address - Phone:912-384-7275
Practice Address - Fax:912-384-4353
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN136145363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily