Healthcare Provider Details

I. General information

NPI: 1366014508
Provider Name (Legal Business Name): SMITH PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2021
Last Update Date: 07/03/2022
Certification Date: 07/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2236 CAHABA VALLEY DR STE 206A
BIRMINGHAM AL
35242-2679
US

IV. Provider business mailing address

PO BOX 382645
BIRMINGHAM AL
35238-2645
US

V. Phone/Fax

Practice location:
  • Phone: 205-583-6661
  • Fax: 617-362-2499
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: PHILLIP SMITH
Title or Position: OWNER
Credential:
Phone: 205-583-6661