Basic Information
| Provider Information | |||||||||
| NPI: | 1891440921 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | ADRIENNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1521 AKINS DR | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374111602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238037142 | ||||||||
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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: | 02/17/2022 | ||||||||
| LastUpdateDate: | 02/17/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 74251 | TN | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.