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NPI Code Detail

MEDICARE: DR. MIMI CHAMBLIN SMITH M.D.

MEDICARE: DR. MIMI CHAMBLIN 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
1208600000XSurgery Physician22700AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
251000823OTHERALBLUE CROSS BLUE SHIELD
31750341756OTHERALNPI
41922068774OTHERALGROUP NPI
563-0677675OTHERALFEDERAL TAX ID

General Provider Information

NPI Number : 1750341756
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MIMI CHAMBLIN SMITH M.D.
Provider Business Mailing Address
First Line : 2022 BROOKWOOD MEDICAL CTR DR
Second Line : SUITE 313 ACC
City : BIRMINGHAM
State : AL
Zip : 35209-6808
Country : US
Telephone Number : 205-877-2910
Fax Number : 205-879-4649
Provider Business Practice Location Address
First Line : 2022 BROOKWOOD MEDICAL CTR DR
Second Line : SUITE 313 ACC
City : BIRMINGHAM
State : AL
Zip : 35209-6808
Country : US
Telephone Number : 205-877-2910
Fax Number : 205-879-4649
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2006
Last Update Date : 04/10/2014

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