Healthcare Provider Details

I. General information

NPI: 1194718759
Provider Name (Legal Business Name): GEORGE C SMITH SR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60026 HIGHWAY 49
LINEVILLE AL
36266-4735
US

IV. Provider business mailing address

PO BOX 98
LINEVILLE AL
36266-0098
US

V. Phone/Fax

Practice location:
  • Phone: 256-396-2141
  • Fax:
Mailing address:
  • Phone: 256-396-2141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3646
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: