Individual
JACQUELINE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2100 COMER AVE, COLUMBUS, GA 31904-8725
(706) 596-5500
Mailing address
PO BOX 4017, PHENIX CITY, AL 36868-4017
(706) 464-5433
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN054514
GA
Other
Enumeration date
03/19/2025
Last updated
03/19/2025
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