Provider Demographics
NPI:1437042595
Name:SMITH, T'KHIRA (SLP-CCC)
Entity type:Individual
Prefix:
First Name:T'KHIRA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 GRAYTON WAY
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-4839
Mailing Address - Country:US
Mailing Address - Phone:478-662-0381
Mailing Address - Fax:
Practice Address - Street 1:1998 MERCER UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-5457
Practice Address - Country:US
Practice Address - Phone:478-746-1037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA14360307235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist