Healthcare Provider Details

I. General information

NPI: 1205740958
Provider Name (Legal Business Name): MABRY KNOX MACY SMYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5721 USA N DR
MOBILE AL
36688-0001
US

IV. Provider business mailing address

3724 COUNTRY CLUB DR APT C
BIRMINGHAM AL
35213-2857
US

V. Phone/Fax

Practice location:
  • Phone: 251-460-6101
  • Fax:
Mailing address:
  • Phone: 205-531-1710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: