Provider Demographics
NPI:1568492007
Name:SMITH, CHRISTINA CLEM (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:CLEM
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3179 GREEN VALLEY RD STE 408
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-5239
Mailing Address - Country:US
Mailing Address - Phone:205-504-4290
Mailing Address - Fax:619-346-4802
Practice Address - Street 1:2016 STONEGATE TRAIL
Practice Address - Street 2:SUITE 100
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35242
Practice Address - Country:US
Practice Address - Phone:205-504-4290
Practice Address - Fax:619-346-4802
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL255552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009937516Medicaid
AL051004050OtherSPS
ALI19929Medicare UPIN
AL009937516Medicaid