Healthcare Provider Details

I. General information

NPI: 1992977102
Provider Name (Legal Business Name): J D SMITH DPM P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 ROSA LN
FLORENCE AL
35630-1769
US

IV. Provider business mailing address

202 ROSA LN
FLORENCE AL
35630-1769
US

V. Phone/Fax

Practice location:
  • Phone: 256-764-1806
  • Fax: 256-760-8442
Mailing address:
  • Phone: 256-764-1806
  • Fax: 256-760-8442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number#212
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number#212
License Number StateAL

VIII. Authorized Official

Name: DR. JOHN DAVID SMITH
Title or Position: PRESIDENT
Credential: DPM
Phone: 256-764-1806