Healthcare Provider Details

I. General information

NPI: 1366674681
Provider Name (Legal Business Name): LAYLA SMITH WREN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 GOODYEAR AVE
GADSDEN AL
35903-1133
US

IV. Provider business mailing address

851 GOODYEAR AVE
GADSDEN AL
35903-1133
US

V. Phone/Fax

Practice location:
  • Phone: 256-413-6000
  • Fax: 256-413-6001
Mailing address:
  • Phone: 256-413-6000
  • Fax: 256-413-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31434
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: