Basic Information
| Provider Information | |||||||||
| NPI: | 1225441967 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | ERIKA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | PA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HARVEY | ||||||||
| OtherFirstName: | ERIKA | ||||||||
| OtherMiddleName: | PAIGE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 222 GORDON ST # 728 | ||||||||
| Address2: | |||||||||
| City: | BREMEN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301101519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705371234 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 204 ALLEN MEMORIAL DR | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | BREMEN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301102047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705376500 | ||||||||
| FaxNumber: | 7708242600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2014 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.