Individual
NANCY WEDNESDAY SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
STATE PROVIDER
Contact information
Practice address
1705 FELLOWSHIP DR, VALDOSTA, GA 31602-7190
(229) 305-1496
Mailing address
1705 FELLOWSHIP DR, VALDOSTA, GA 31602-7190
(229) 305-1496
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
050381871
GA
Other
Enumeration date
09/25/2023
Last updated
09/25/2023
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