Provider Demographics
NPI:1477824076
Name:SMITH, WHITNEY MCKESSON (MAT, ATC, LAT)
Entity Type:Individual
Prefix:MS
First Name:WHITNEY
Middle Name:MCKESSON
Last Name:SMITH
Suffix:
Gender:F
Credentials:MAT, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 COLLEGE DR
Mailing Address - Street 2:STATION 14
Mailing Address - City:LIVINGSTON
Mailing Address - State:AL
Mailing Address - Zip Code:35470-2098
Mailing Address - Country:US
Mailing Address - Phone:205-652-3489
Mailing Address - Fax:205-652-3799
Practice Address - Street 1:1 COLLEGE DR
Practice Address - Street 2:STATION 14
Practice Address - City:LIVINGSTON
Practice Address - State:AL
Practice Address - Zip Code:35470-2098
Practice Address - Country:US
Practice Address - Phone:205-652-3489
Practice Address - Fax:205-652-3799
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10972255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer