Healthcare Provider Details

I. General information

NPI: 1760803258
Provider Name (Legal Business Name): GRANT SMITH INSURANCE AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2013
Last Update Date: 12/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 LOMB AVE SW STE F
BIRMINGHAM AL
35211-1200
US

IV. Provider business mailing address

800 LOMB AVE SW STE F
BIRMINGHAM AL
35211-1200
US

V. Phone/Fax

Practice location:
  • Phone: 205-613-3229
  • Fax: 205-868-3902
Mailing address:
  • Phone: 205-613-3229
  • Fax: 205-868-3902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number0297637
License Number StateAL

VIII. Authorized Official

Name: MS. CASSANDRA G SMITH
Title or Position: AGENT AND OWNER
Credential:
Phone: 205-613-3229