Provider Demographics
NPI:1710520440
Name:SMITH, AMIE LOVETTE
Entity Type:Individual
Prefix:
First Name:AMIE
Middle Name:LOVETTE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8295 SOUTHAMPTON PKWY LOT 8
Mailing Address - Street 2:
Mailing Address - City:DREWRYVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23844-2059
Mailing Address - Country:US
Mailing Address - Phone:804-926-9393
Mailing Address - Fax:
Practice Address - Street 1:8295 SOUTHAMPTON PKWY LOT 8
Practice Address - Street 2:
Practice Address - City:DREWRYVILLE
Practice Address - State:VA
Practice Address - Zip Code:23844-2059
Practice Address - Country:US
Practice Address - Phone:804-926-9393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
1234OtherNON EMERGENCY MEDICAL TRANSPORTATION
VA1234OtherNON EMERGENCY MEDICAL TRANSPORTATION