Healthcare Provider Details

I. General information

NPI: 1154189298
Provider Name (Legal Business Name): MARCUS HAROLD SMITH RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 6TH AVE S
BIRMINGHAM AL
35233-1932
US

IV. Provider business mailing address

1802 6TH AVE S
BIRMINGHAM AL
35233-1932
US

V. Phone/Fax

Practice location:
  • Phone: 205-542-3638
  • Fax:
Mailing address:
  • Phone: 205-542-3638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1-179819
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-179819
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: