Healthcare Provider Details

I. General information

NPI: 1407817760
Provider Name (Legal Business Name): DEBORAH SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 PIEDMONT CUTOFF
GADSDEN AL
35903-2708
US

IV. Provider business mailing address

PO BOX 97
GADSDEN AL
35902-0097
US

V. Phone/Fax

Practice location:
  • Phone: 256-492-0131
  • Fax:
Mailing address:
  • Phone: 256-492-0131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number00024130
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: