Individual
SHANTA MONTRAILE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNA
Contact information
Practice address
121 W COLLEGE ST, GRIFFIN, GA 30224-4220
(678) 702-4639
(678) 692-8131
Mailing address
121 W COLLEGE ST, GRIFFIN, GA 30224-4220
(678) 702-4639
(678) 692-8131
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
311Z00000X
Custodial Care Facility
Primary
PCH008442
GA
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Enumeration date
08/01/2021
Last updated
08/01/2021
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