Healthcare Provider Details

I. General information

NPI: 1780907584
Provider Name (Legal Business Name): ALICE HICKMAN SMITH AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2010
Last Update Date: 03/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 PATTERSON AVE SUITE 100
RICHMOND VA
23226-2025
US

IV. Provider business mailing address

5501 PATTERSON AVE SUITE 100
RICHMOND VA
23226-2025
US

V. Phone/Fax

Practice location:
  • Phone: 804-358-7992
  • Fax:
Mailing address:
  • Phone: 804-358-7992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2201001420
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number2201001420
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: