Individual
WANDA G. SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
163 E TOLLISON ST, BAXLEY, GA 31513-0120
(912) 367-4122
(912) 367-4136
Mailing address
PO BOX 2070, BAXLEY, GA 31515-2070
(912) 367-4122
(912) 367-4136
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN038139
GA
Other
Enumeration date
11/30/2006
Last updated
02/03/2010
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