Healthcare Provider Details

I. General information

NPI: 1588502116
Provider Name (Legal Business Name): MR. SAMUEL BERNARD SMITH JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 MARTIN LUTHER KING JR AVE SW APT B606
WASHINGTON DC
20032-4980
US

IV. Provider business mailing address

3813 COPPERVILLE WAY
FORT WASHINGTON MD
20744-1087
US

V. Phone/Fax

Practice location:
  • Phone: 202-421-3065
  • Fax:
Mailing address:
  • Phone: 227-220-7627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: