Healthcare Provider Details

I. General information

NPI: 1093120933
Provider Name (Legal Business Name): CLIFFORD C SMITH III DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 S WATER ST
LOUISA KY
41230-1347
US

IV. Provider business mailing address

203 S WATER ST
LOUISA KY
41230-1347
US

V. Phone/Fax

Practice location:
  • Phone: 606-649-2211
  • Fax: 606-638-1399
Mailing address:
  • Phone: 606-649-2211
  • Fax: 606-638-1399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04144
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: