Raegan Marree Smith, MS, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT003737 Issued in GA

Practice address

2210 12TH Ave
Albany, GA 31707-3251

Phone

(812) 340-1554

NPI assigned

Aug 29, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1472428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613520000000",
    "number": "1134675325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2210 12TH AVE",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317073251",
            "telephone_number": "812-340-1554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2210 12TH AVE",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317073251",
            "telephone_number": "812-340-1554"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3641 E Homestead Dr",
            "address_purpose": "LOCATION",
            "city": "Bloomington",
            "state": "IN",
            "postal_code": "474014218",
            "country_code": "US",
            "telephone_number": "812-340-1554",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "RAEGAN",
        "middle_name": "MARREE",
        "name_prefix": "Ms.",
        "credential": "MS, LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-29",
        "last_updated": "2021-02-17",
        "certification_date": "2021-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IN",
            "license": "2255A2300X",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "GA",
            "license": "AT003737",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Latandria Smith, PHD, LCSW
• Latiffi Stevondria Smith
• Lisa Merritt Smith, RPH
• Michele Wilson Smith, L.D.
• Nettie Pearl Smith
• Shamonica Lataya Smith
• Sheri B Smith, P.A.
• Stephanie Renee Smith
• Tania Smith, M.D.
• Tara Elani Smith, PHARMD

• Athletic Trainer in Albany, GA
• Providers in Albany, GA by specialty
• Athletic Trainer in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.