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General NPI Number Information
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NPI Number | 1255887949
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Entity Type | Individual
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Provider Name | CHRIS SMALLWOOD II
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Gender | Male
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 6128 ST ANDREWS DR
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City | CANFIELD
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State | OH
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Zip | 44406
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Country | US
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Telephone | 330-647-3137
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Fax | 800-304-3604
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Provider Business Mailing Address
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Address Line | 202 N MERIDIAN RD
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City | YOUNGSTOWN
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State | OH
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Zip | 44509-1858
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Country | US
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Telephone | 330-647-3137
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Fax | 800-304-3604
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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 | 172A00000X
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Taxonomy Name | Driver
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License Number | 2005483
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License Number State | OH
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