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General NPI Number Information
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NPI Number | 1023337037
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Entity Type | Individual
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Provider Name | GLENNIS DALE SMITH P.A.
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Gender | Male
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Dates
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Enumeration Date | 06/01/2010
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Last Update Date | 06/01/2010
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Provider Practice Location Address
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Address Line | 5300 57TH ST N
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City | BIRMINGHAM
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State | AL
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Zip | 35217-3328
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Country | US
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Telephone | 205-808-3220
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Fax |
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Provider Business Mailing Address
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Address Line | 20 SCOTTSDALE DR
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City | ALABASTER
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State | AL
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Zip | 35007-8994
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Country | US
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Telephone | 205-685-9777
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA709
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License Number State | AL
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