Provider Demographics
NPI:1346613700
Name:ROYSHANDA SMITH LLC
Entity Type:Organization
Organization Name:ROYSHANDA SMITH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROYSHANDA
Authorized Official - Middle Name:CZELL
Authorized Official - Last Name:SMITG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-957-3448
Mailing Address - Street 1:120 N LAFAYETTE ST STE A
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36604-2258
Mailing Address - Country:US
Mailing Address - Phone:504-957-3448
Mailing Address - Fax:
Practice Address - Street 1:120 N LAFAYETTE ST STE A
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-2258
Practice Address - Country:US
Practice Address - Phone:504-957-3448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-07
Last Update Date:2015-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL29098302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1052159Medicaid