MEDICARE: JANA SMITH

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	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1275357105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANA SMITH

Provider Business Mailing Address
First Line	:	1830 MONTCLAIR RD STE A
Second Line	:
City	:	IRONDALE
State	:	AL
Zip	:	35210-2645
Country	:	US
Telephone Number	:	205-775-0300
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 HIGHWAY 78 E STE 200
Second Line	:
City	:	JASPER
State	:	AL
Zip	:	35501-8950
Country	:	US
Telephone Number	:	205-512-1015
Fax Number	:	205-618-9706

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

Provider Enumeration Date	:	11/07/2024
Last Update Date	:	11/07/2024

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Directions to “ JANA SMITH ” Practice Location

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