Provider Demographics
NPI:1477733269
Name:WILBURN A. SMITH, JR., M.D.
Entity Type:Organization
Organization Name:WILBURN A. SMITH, JR., M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:H
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:334-281-6363
Mailing Address - Street 1:4131 CARMICHAEL RD
Mailing Address - Street 2:SUITE 28
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2801
Mailing Address - Country:US
Mailing Address - Phone:334-281-6363
Mailing Address - Fax:334-284-4253
Practice Address - Street 1:4131 CARMICHAEL RD
Practice Address - Street 2:SUITE 28
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2801
Practice Address - Country:US
Practice Address - Phone:334-281-6363
Practice Address - Fax:334-284-4253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9125207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000083838Medicaid
AL000083838Medicaid
ALG975Medicare PIN