MEDICARE: DR. JOANNE HOLLIDAY SMITH D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	DO235	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104821099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOANNE HOLLIDAY SMITH D.O.

Provider Business Mailing Address
First Line	:	PO BOX 609
Second Line	:
City	:	ANDALUSIA
State	:	AL
Zip	:	36420-1211
Country	:	US
Telephone Number	:	334-222-0184
Fax Number	:	334-222-0625

Provider Business Practice Location Address
First Line	:	601 W BYPASS
Second Line	:
City	:	ANDALUSIA
State	:	AL
Zip	:	36420-4732
Country	:	US
Telephone Number	:	334-222-0184
Fax Number	:	334-222-0625

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	11/05/2023

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