Provider Demographics
NPI:1477526762
Name:SMITH, DAVID WESLEY (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WESLEY
Last Name:SMITH
Suffix:
Gender:M
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:PO BOX 5430
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36205-0430
Mailing Address - Country:US
Mailing Address - Phone:256-237-1624
Mailing Address - Fax:256-241-2277
Practice Address - Street 1:171 TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36205-4101
Practice Address - Country:US
Practice Address - Phone:256-237-1624
Practice Address - Fax:256-241-2277
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17281174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51037575OtherBLUE CROSS BLUE SHIELD
AL020040526OtherUNITED HEALTHCARE
AL000037575Medicaid
AL41124OtherHEALTH STRATEGIES
ALF56843Medicare UPIN
AL000037575Medicaid