Provider Demographics
NPI:1184346785
Name:SMALLS, FALLON GABRIELLE (CBS)
Entity type:Individual
Prefix:MRS
First Name:FALLON
Middle Name:GABRIELLE
Last Name:SMALLS
Suffix:
Gender:F
Credentials:CBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9228 SPRING ACRES RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3031
Mailing Address - Country:US
Mailing Address - Phone:240-462-5226
Mailing Address - Fax:
Practice Address - Street 1:9228 SPRING ACRES RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3031
Practice Address - Country:US
Practice Address - Phone:240-462-5226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDB74268C8E1174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN