Healthcare Provider Details

I. General information

NPI: 1780050641
Provider Name (Legal Business Name): ADAM SMITH ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2015
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 WESTHAMPTON WAY ROOM 163; ROBINS CENTER
RICHMOND VA
23173-0001
US

IV. Provider business mailing address

23 WESTHAMPTON WAY ROOM 163; ROBINS CENTER
UNIVERSITY OF RICHMOND VA
23173
US

V. Phone/Fax

Practice location:
  • Phone: 804-287-6523
  • Fax: 804-289-8791
Mailing address:
  • Phone: 804-287-6523
  • Fax: 804-289-8791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0126001381
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: