Provider Demographics
NPI:1497887939
Name:SMITH, EDDY ARNOLD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:EDDY
Middle Name:ARNOLD
Last Name:SMITH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 RAINBOW DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5510
Mailing Address - Country:US
Mailing Address - Phone:256-547-0160
Mailing Address - Fax:
Practice Address - Street 1:2108 RAINBOW DR
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5510
Practice Address - Country:US
Practice Address - Phone:256-547-0160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX01863363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical