Jordan Smith, | |
2700 Patrick Henry Pkwy, Stockbridge, GA 30281-9108 | |
(770) 464-5088 | |
Not Available |
Full Name | Jordan Smith |
---|---|
Gender | Male |
Speciality | Speech-language Pathologist |
Location | 2700 Patrick Henry Pkwy, Stockbridge, Georgia |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1821789538 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
235Z00000X | Speech-language Pathologist | SLP011716 (Georgia) | Primary |
Provider Name | Empowerme Rehabilitation Georgia, Llc |
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Provider Type | Part B Supplier - Physical/occupational Therapy Group In Private Practice |
Provider Identifiers | NPI Number: 1952934374 PECOS PAC ID: 4284063835 Enrollment ID: O20200401003230 |
Mailing Address | Practice Location Address |
---|---|
Jordan Smith, 3640 S Fulton Ave Unit 1504, Hapeville, GA 30354-1773 Ph: (706) 619-4337 | Jordan Smith, 2700 Patrick Henry Pkwy, Stockbridge, GA 30281-9108 Ph: (770) 464-5088 |
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