Healthcare Provider Details

I. General information

NPI: 1063444628
Provider Name (Legal Business Name): ROYSHANDA CZELL SMITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 E LOVE JOY LOOP STE 650
PRICHARD AL
36610-3923
US

IV. Provider business mailing address

107 E LOVE JOY LOOP
MOBILE AL
36610-3923
US

V. Phone/Fax

Practice location:
  • Phone: 251-753-4328
  • Fax: 251-753-4328
Mailing address:
  • Phone: 504-957-3448
  • Fax: 504-957-3448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number29098
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number69962
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: