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Organization

LIFEWAY TRAINING INSTITUTE CO

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. JULENE DOROTHY SMITH PMHNP-BC (OWNER)
(229) 403-9964
Entity
Organization

Contact information

Practice address
410 4TH ST SE, CAIRO, GA 39828-2775
(229) 403-9964
Mailing address
410 4TH ST SE, CAIRO, GA 39828-2775
(229) 403-9964

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1083071898
BLUE CROSS BLUE SHIELD/ANTHEM
GA
05
1083071898
GA
Enumeration date
01/23/2022
Last updated
08/25/2022
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