MEDICARE: CLARA MAE SMITH RD

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
1	133V00000X	Registered Dietitian	1281	AL

General Provider Information

NPI Number	:	1598901050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARA MAE SMITH RD

Provider Business Mailing Address
First Line	:	7841 RUGBY CT
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35206-4931
Country	:	US
Telephone Number	:	205-833-0086
Fax Number	:	205-833-0086

Provider Business Practice Location Address
First Line	:	7841 RUGBY CT
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35206-4931
Country	:	US
Telephone Number	:	205-833-0086
Fax Number	:	205-833-0086

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2009
Last Update Date	:	01/05/2009

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