Individual provider Active NPI

Chinara Smith, NURSE PRACTITIONER

  • Psychiatric/Mental Health Nurse Practitioner
  • Loganville, GA
National Provider Identifier
1407454366
Registry record updated Mar 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
2020015499 Issued in GA
Practice address
505 Ashton Manor Dr
Loganville, GA 30052-5329
Phone
(404) 992-5570
NPI assigned
Oct 13, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 12, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 2020015499 GA Primary

Addresses

Primary practice location

505 Ashton Manor Dr
Loganville, GA 30052-5329

Mailing address

505 Ashton Manor Dr
Loganville, GA 30052-5329
Phone (404) 992-5570

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, CO2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210324001198 GA Practitioner - Nurse Practitioner 7719394576 Reassigns benefits to 3 organizations
I20250220004089 CO Practitioner - Nurse Practitioner 7719394576 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2020015499GAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Grow Healthcare Group PA Psychiatric/Mental Health CurrentSince Dec 20, 2024 Accepting new patients
Capeside Psychiatry, PLLC CurrentSince Oct 1, 2023 Accepting new patients
Peace of Mind Psychiatric Services PC PastSince Oct 1, 2020 Accepting new patients

Locations

5445 Dtc Pkwy
Ph 4
Greenwood Village, CO 80111
Phone (720) 571-4874

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

715 Peachtree St NE
Ste 100
Atlanta, GA 30308
Phone (202) 972-4964

146 Depot St
Ste 202
Blue Ridge, GA 30513
Phone (941) 780-4192

Organizations & group practices 5

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

NPI Registry JSON

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

{
    "created_epoch": "1602547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741737600000",
    "number": "1407454366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 ASHTON MANOR DR",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300525329",
            "telephone_number": "404-992-5570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 ASHTON MANOR DR",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300525329",
            "telephone_number": "404-992-5570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "CHINARA",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-13",
        "last_updated": "2025-03-12",
        "certification_date": "2025-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "GA",
            "license": "2020015499",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loganville, GA

Sources for this page

Verify at the official NPI Registry.