Khaliliah Kendra Smith

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

12841 Issued in GA

Practice address

1005 Milstead Ave NE Ste 103
Conyers, GA 30012-4509

Phone

(770) 860-8549

Fax

(866) 210-1269

NPI assigned

Apr 5, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1649116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649116800000",
    "number": "1760123657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1705 DRUIDS CT SE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300132979",
            "telephone_number": "678-851-8703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 MILSTEAD AVE NE STE 103",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300124509",
            "telephone_number": "770-860-8549",
            "fax_number": "866-210-1269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KHALILIAH",
        "middle_name": "KENDRA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-05",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "12841",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ethel L Smith, MD
• Eulanda S Smith
• Harmon Andrew Smith, M.D.
• Kaitlyn Smith, PA-C
• Kanisha Smith
• Letrece Smith
• Marcia Wootson Smith, LPC
• Shawndria Nicole Smith, LCSW
• Summer Smith, FNP-C
• Suzanne Patrice Smith, MD

• Professional Counselor in Conyers, GA
• Providers in Conyers, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 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.