Healthcare Provider Details

I. General information

NPI: 1982698387
Provider Name (Legal Business Name): WILLIAM PHILLIP SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date: 03/24/2006
Reactivation Date: 04/05/2006

III. Provider practice location address

724 STONE AVE
TALLADEGA AL
35160-2219
US

IV. Provider business mailing address

724 STONE AVE
TALLADEGA AL
35160-2219
US

V. Phone/Fax

Practice location:
  • Phone: 256-362-1410
  • Fax: 256-362-0186
Mailing address:
  • Phone: 256-362-1410
  • Fax: 256-362-0186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9293
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: