Provider Demographics
NPI:1235247230
Name:SMITH, CHERYL AUSTIN (MD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:AUSTIN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 JORDAN ST STE 240
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4512
Mailing Address - Country:US
Mailing Address - Phone:877-276-4846
Mailing Address - Fax:318-252-0560
Practice Address - Street 1:820 JORDAN ST STE 240
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4512
Practice Address - Country:US
Practice Address - Phone:877-276-4846
Practice Address - Fax:318-252-0560
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2023-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023233207Q00000X, 2083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1495671Medicaid
LA1495671Medicaid
G98345Medicare UPIN