Provider Demographics
NPI:1609340009
Name:SMITH, MAGGIE MALAINE
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:MALAINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:MALAINE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ATS
Mailing Address - Street 1:4611 CREEK WOOD PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30507-8874
Mailing Address - Country:US
Mailing Address - Phone:770-533-3073
Mailing Address - Fax:
Practice Address - Street 1:4611 CREEK WOOD PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30507-8874
Practice Address - Country:US
Practice Address - Phone:770-533-3073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program