Basic Information
| Provider Information | |||||||||
| NPI: | 1679195341 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | WHITNEY | ||||||||
| MiddleName: | ALICE | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 282 MISTY RIDGE LN | ||||||||
| Address2: | |||||||||
| City: | RINGGOLD | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307362926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4235829663 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4083 CLOUD SPRINGS RD | ||||||||
| Address2: | |||||||||
| City: | RINGGOLD | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307368411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008056989 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2020 | ||||||||
| LastUpdateDate: | 05/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WA0400X | RN286677 | GA | Y | Nursing Service Providers | Registered Nurse | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | RN286677 | 01 | GA | RN LICENSE | OTHER |