Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 2013-00257 | NC |
N | 111NI0900X | Internist | 2013-00257 | NC |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | MD.38191 | AL |
NPI | 1245556307 |
---|---|
Provider Name | Dr. Justin William Smith |
First Address | Montgomery, AL 36124-1587 |
Second Address | Montgomery, AL 36117-3507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2010 |
Last Update Date | 10/03/2021 |