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General NPI Number Information
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NPI Number | 1669882122
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Entity Type | Individual
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Provider Name | JUSTIN R SMITH DO
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Gender | Male
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Dates
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Enumeration Date | 05/05/2014
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Last Update Date | 05/06/2024
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Provider Practice Location Address
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Address Line | UNIT 45011 BOX BG
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City | APO
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State | AP
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Zip | 96343-5011
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Country | US
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Telephone | 46-407-4175
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Fax |
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Provider Business Mailing Address
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Address Line | BG CRAWFORD F. SAMS HEALTH CLINIC UNIT 45011 BOX BG
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City | APO
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State | AP
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Zip | 96343-5011
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Country | US
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Telephone |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0102205283
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License Number State | VA
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