Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | 17-1104 | AL |
NPI | 1295240588 |
---|---|
Provider Name | Mr. Eric Todd Smith |
First Address | Decatur, AL 35601-3595 |
Second Address | Decatur, AL 35601-3595 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2017 |
Last Update Date | 07/12/2017 |