Provider Demographics
NPI:1700378197
Name:SMITH MORETZ, TONYA MICHELLE (NP-C)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:MICHELLE
Last Name:SMITH MORETZ
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 SADDLEBROOK GLEN DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-9330
Mailing Address - Country:US
Mailing Address - Phone:770-217-0627
Mailing Address - Fax:
Practice Address - Street 1:4355 BROWNS BRIDGE RD STE 1
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-4554
Practice Address - Country:US
Practice Address - Phone:770-771-0550
Practice Address - Fax:770-771-5051
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN230288363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily