Provider Demographics
NPI:1073663589
Name:SMITH, WILLIAM G JR (CRNA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:G
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 NOTTOWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-2979
Mailing Address - Country:US
Mailing Address - Phone:334-793-4610
Mailing Address - Fax:334-791-7981
Practice Address - Street 1:103 NOTTOWAY BLVD
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-2979
Practice Address - Country:US
Practice Address - Phone:334-793-4610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1022818367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered