Healthcare Provider Details

I. General information

NPI: 1114235496
Provider Name (Legal Business Name): CHRISTOPHER C SMITH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2010
Last Update Date: 08/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 E MORRIS ST
SAMSON AL
36477-1229
US

IV. Provider business mailing address

98 E MORRIS ST
SAMSON AL
36477-1229
US

V. Phone/Fax

Practice location:
  • Phone: 334-898-2728
  • Fax: 334-898-2774
Mailing address:
  • Phone: 334-898-2728
  • Fax: 334-898-2774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS10782
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO.1188
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: