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NPI Code Detail

MEDICARE: LAKISHA DIONNE MOORE SMITH M.D.

MEDICARE: LAKISHA DIONNE MOORE SMITH M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianMD.36669AL

General Provider Information

NPI Number : 1033566062
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAKISHA DIONNE MOORE SMITH M.D.
Provider Business Mailing Address
First Line : 2700 ROGERS DR STE 102
Second Line :
City : HOMEWOOD
State : AL
Zip : 35209-2018
Country : US
Telephone Number : 205-379-0975
Fax Number : 205-379-0943
Provider Business Practice Location Address
First Line : 2700 ROGERS DR STE 102
Second Line :
City : HOMEWOOD
State : AL
Zip : 35209-2018
Country : US
Telephone Number : 205-379-0975
Fax Number : 205-379-0943
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2016
Last Update Date : 01/13/2026

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