Provider Demographics
NPI:1164258729
Name:SMITH-DAVIS, CARRIE T
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:T
Last Name:SMITH-DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1386
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30453-1386
Mailing Address - Country:US
Mailing Address - Phone:404-576-8634
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1386
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30453-1386
Practice Address - Country:US
Practice Address - Phone:404-576-8634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA745-10008246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty