Healthcare Provider Details

I. General information

NPI: 1629933197
Provider Name (Legal Business Name): COURTNEY SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3298 FORT LINCOLN DR NE APT 607
WASHINGTON DC
20018-4318
US

IV. Provider business mailing address

3822 DAVIS PL NW APT B2
WASHINGTON DC
20007-1357
US

V. Phone/Fax

Practice location:
  • Phone: 202-977-9141
  • Fax:
Mailing address:
  • Phone: 202-539-3853
  • 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: