Provider Demographics
NPI:1053713560
Name:SMITH, ERIN MICHELLE (FNP-BC)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:MICHELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 HART ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:GA
Mailing Address - Zip Code:31329-4976
Mailing Address - Country:US
Mailing Address - Phone:912-659-7460
Mailing Address - Fax:
Practice Address - Street 1:11702 MERCY BLVD STE 2G
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1777
Practice Address - Country:US
Practice Address - Phone:912-920-8898
Practice Address - Fax:912-920-4418
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN212021363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0031522495EMedicaid