Provider Demographics
NPI:1679179543
Name:LAYLA RENEE LUNDQUIST-SMITH MD, LLC
Entity Type:Organization
Organization Name:LAYLA RENEE LUNDQUIST-SMITH MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDQUIST-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-529-4960
Mailing Address - Street 1:609 E LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:ATMORE
Mailing Address - State:AL
Mailing Address - Zip Code:36502
Mailing Address - Country:US
Mailing Address - Phone:251-362-6960
Mailing Address - Fax:
Practice Address - Street 1:609 E LAUREL ST
Practice Address - Street 2:
Practice Address - City:ATMORE
Practice Address - State:AL
Practice Address - Zip Code:36502
Practice Address - Country:US
Practice Address - Phone:251-362-6960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty