Individual
SHAMONICA LATAYA SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
615 KINGSBURY LN, ALBANY, GA 31707-4643
(229) 296-6442
Mailing address
615 KINGSBURY LN, ALBANY, GA 31707-4643
(229) 296-6442
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
11/14/2019
Last updated
11/14/2019
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