Provider Demographics
NPI:1851613475
Name:SMITH, BARRY CHILDS (PHYSICIANS ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:CHILDS
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHYSICIANS ASSISTANT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:751 E 9 MILE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1990
Mailing Address - Country:US
Mailing Address - Phone:248-336-2850
Mailing Address - Fax:
Practice Address - Street 1:30500 VAN DYKE AVE STE 203
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2109
Practice Address - Country:US
Practice Address - Phone:248-480-9066
Practice Address - Fax:248-480-9062
Is Sole Proprietor?:No
Enumeration Date:2010-02-23
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001288363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant