Provider Demographics
NPI:1316384464
Name:SMILEY HEALTH GROUP LLC
Entity Type:Organization
Organization Name:SMILEY HEALTH GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NCMA, PPA, OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CORNELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-215-7969
Mailing Address - Street 1:5780 HYDE PARK DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3031
Mailing Address - Country:US
Mailing Address - Phone:334-215-7969
Mailing Address - Fax:
Practice Address - Street 1:5780 HYDE PARK DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3031
Practice Address - Country:US
Practice Address - Phone:334-215-7969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization