Provider Demographics
NPI:1508829722
Name:SMITH, BEATRICE L (MD)
Entity Type:Individual
Prefix:DR
First Name:BEATRICE
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 LEIGHTON AVE
Mailing Address - Street 2:SUITE 601
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5700
Mailing Address - Country:US
Mailing Address - Phone:256-236-4426
Mailing Address - Fax:256-238-8830
Practice Address - Street 1:901 LEIGHTON AVE
Practice Address - Street 2:SUITE 601
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5700
Practice Address - Country:US
Practice Address - Phone:256-236-4426
Practice Address - Fax:256-238-8830
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00017655174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL040012137OtherRAILROAD MEDICARE
AL528601340Medicaid
AL528601340Medicaid
AL000030013Medicare PIN