Provider Demographics
NPI:1821009044
Name:SMITH, NATHAN
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1717 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1801
Practice Address - Country:US
Practice Address - Phone:800-822-8816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL155072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000077910Medicaid
AL051547744OtherBLUE CROSS
AL330500209OtherMEDICAID REHAB
AL82715OtherBLUE CROSS
AL000082715Medicaid
AL051598533OtherBLUE CROSS
AL100634Medicaid
AL123258Medicaid
AL51599354OtherBLUE CROSS
AL051502084OtherFEDERAL BLUE CROSS
AL051525958OtherBCBS
AL123642Medicaid
AL009976635Medicaid
AL123640Medicaid
AL51110336OtherBLUE CROSS
AL13570OtherHEALTHSPRING
AL100634Medicaid
AL000077910Medicaid