Healthcare Provider Details

I. General information

NPI: 1316384464
Provider Name (Legal Business Name): SMILEY HEALTH GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5780 HYDE PARK DR
MONTGOMERY AL
36117-3031
US

IV. Provider business mailing address

5780 HYDE PARK DR
MONTGOMERY AL
36117-3031
US

V. Phone/Fax

Practice location:
  • Phone: 334-215-7969
  • Fax:
Mailing address:
  • Phone: 334-215-7969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: MS. CORNELIA SMILEY
Title or Position: NCMA, PPA, OWNER
Credential:
Phone: 334-215-7969