Provider Demographics
NPI:1114235496
Name:SMITH, CHRISTOPHER C (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:C
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:98 E MORRIS ST
Mailing Address - Street 2:
Mailing Address - City:SAMSON
Mailing Address - State:AL
Mailing Address - Zip Code:36477-1229
Mailing Address - Country:US
Mailing Address - Phone:334-898-2728
Mailing Address - Fax:334-898-2774
Practice Address - Street 1:98 E MORRIS ST
Practice Address - Street 2:
Practice Address - City:SAMSON
Practice Address - State:AL
Practice Address - Zip Code:36477-1229
Practice Address - Country:US
Practice Address - Phone:334-898-2728
Practice Address - Fax:334-898-2774
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2011-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10782207Q00000X
ALDO.1188207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine