Provider Demographics
NPI:1174925622
Name:THOMAS-SMITH, CYNTHIA L (RN)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:THOMAS-SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 E 9TH ST NORTH
Mailing Address - Street 2:BLDG 4970, RM 216
Mailing Address - City:FT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314
Mailing Address - Country:US
Mailing Address - Phone:912-435-1330
Mailing Address - Fax:912-435-6142
Practice Address - Street 1:703 E 9TH ST NORTH
Practice Address - Street 2:BLDG 4970, RM 216
Practice Address - City:FT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314
Practice Address - Country:US
Practice Address - Phone:912-435-1330
Practice Address - Fax:912-435-6142
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN183447163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management