Individual
LARISSA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2195 PACE ST, COVINGTON, GA 30014-6656
(470) 444-1005
Mailing address
922 HIGHWAY 81 E UNIT 410, MCDONOUGH, GA 30252-2978
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN231604
GA
Other
Enumeration date
04/23/2021
Last updated
06/02/2025
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