Raven L Smith

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN149626 Issued in GA

Practice address

201 Morningside Dr
Sandersville, GA 31082-2426

Phone

(478) 552-3210

Fax

(478) 553-1832

NPI assigned

Apr 9, 2020

Last updated

Apr 20, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Washington County Board of Health

  • Public Health or Welfare Agency
  • Sandersville, GA
  • NPI 1124038096
  NPD

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

{
    "created_epoch": "1586390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650412800000",
    "number": "1346869427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 MORNINGSIDE DR",
            "city": "SANDERSVILLE",
            "state": "GA",
            "postal_code": "310822426",
            "telephone_number": "478-552-3210",
            "fax_number": "478-553-1832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 MORNINGSIDE DR",
            "city": "SANDERSVILLE",
            "state": "GA",
            "postal_code": "310822426",
            "telephone_number": "478-552-3210",
            "fax_number": "478-553-1832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "RAVEN",
        "middle_name": "L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-09",
        "last_updated": "2022-04-20",
        "certification_date": "2022-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "GA",
            "license": "RN149626",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN149626",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003257057A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ramona Sheppard
• John Dawson Shipp V
• Smith Medical Nursing Care Center, Inc
• Brandy Alexis Smith, PHARMD
• Melinda Smith, RPH
• Stacey H Williford LLC (Cardinal Healthcare)
• Janice Dudley Stahl, CRNA
• Tyra Benet Stephens, PHARMD
• Subhash S Pujara MD LLC
• Jean Sumner, M.D.

• Family Nurse Practitioner in Sandersville, GA
• Providers in Sandersville, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2022; 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.