Provider Demographics
NPI:1376262931
Name:SMITH, CHASE WILLIAM
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:WILLIAM
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 4TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-1600
Mailing Address - Country:US
Mailing Address - Phone:256-499-2849
Mailing Address - Fax:
Practice Address - Street 1:706 4TH AVE NE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AL
Practice Address - Zip Code:36265-1600
Practice Address - Country:US
Practice Address - Phone:256-499-2849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program