Provider Demographics
NPI:1043618879
Name:SMITH, CAROLYN ADELE
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ADELE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 RIVERHILLS BUSINESS PARK
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5036
Mailing Address - Country:US
Mailing Address - Phone:205-995-0899
Mailing Address - Fax:205-995-0451
Practice Address - Street 1:200 RIVERHILLS BUSINESS PARK
Practice Address - Street 2:SUITE 250
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-5036
Practice Address - Country:US
Practice Address - Phone:205-995-0899
Practice Address - Fax:205-995-0451
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1143114363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics