Basic Information
| Provider Information | |||||||||
| NPI: | 1093796880 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | DONALD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1940 STONEGATE DR STE 130 | ||||||||
| Address2: | |||||||||
| City: | VESTAVIA HLS | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352422541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059779876 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1722 PINE ST | ||||||||
| Address2: | STE 408 | ||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361061159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059779876 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2005 | ||||||||
| LastUpdateDate: | 09/29/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 8751 | AL | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 02537 | 05 | AL | MEDICAID |