Healthcare Provider Details

I. General information

NPI: 1801153457
Provider Name (Legal Business Name): ANTON D SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 06/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 12TH ST SE STE G35
WASHINGTON DC
20003
US

IV. Provider business mailing address

4079 MINNESOTA AVE NE APT22
WASHINGTON DC
20019-3555
US

V. Phone/Fax

Practice location:
  • Phone: 202-544-8090
  • Fax: 202-544-8091
Mailing address:
  • Phone: 202-517-4280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA5208
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: