Individual
MALINDA SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
740 FLETCHER ST, CEDARTOWN, GA 30125-3249
(770) 748-1500
Mailing address
740 FLETCHER ST, CEDARTOWN, GA 30125-3249
(770) 748-1500
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1699806240
—
GA
Enumeration date
01/25/2019
Last updated
01/25/2019
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