Provider Demographics
NPI:1982020756
Name:SMART START PEDIATRICS LLC
Entity Type:Organization
Organization Name:SMART START PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING CONTACT/OFFICE MANAGE
Authorized Official - Prefix:
Authorized Official - First Name:LASHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-891-0300
Mailing Address - Street 1:460 AL HIGHWAY 75 N
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35951-3838
Mailing Address - Country:US
Mailing Address - Phone:256-891-0300
Mailing Address - Fax:256-891-7461
Practice Address - Street 1:460 AL HIGHWAY 75 N
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35951-3838
Practice Address - Country:US
Practice Address - Phone:256-891-0300
Practice Address - Fax:256-891-7461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-17
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208000000X
AL261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty