Provider Demographics
NPI:1609825959
Name:SMITH, JEFFREY D (CRNA)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:D
Last Name:SMITH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2644
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35202-2644
Mailing Address - Country:US
Mailing Address - Phone:205-322-1808
Mailing Address - Fax:205-322-1851
Practice Address - Street 1:1440 HIGHWAY DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-1951
Practice Address - Country:US
Practice Address - Phone:256-241-2230
Practice Address - Fax:256-241-2235
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-049134367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51504038OtherBLUE SHIELD
AL051504038Medicaid
AL430074751OtherPALMETTO GBA
R76062Medicare UPIN
AL430074751OtherPALMETTO GBA