Provider Demographics
NPI:1902857154
Name:SMELLEY, ANGELA KYNARD (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:KYNARD
Last Name:SMELLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:LYNN
Other - Last Name:KYNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1000 FAIRFAX PARK
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2806
Mailing Address - Country:US
Mailing Address - Phone:205-366-9181
Mailing Address - Fax:205-366-9182
Practice Address - Street 1:1000 FAIRFAX PARK
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2806
Practice Address - Country:US
Practice Address - Phone:205-366-9181
Practice Address - Fax:205-366-9182
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21061207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
051517558Medicare ID - Type Unspecified
ALG61745Medicare UPIN