Provider Demographics
NPI:1184422438
Name:SMITH, GARY DANIEL
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:DANIEL
Last Name:SMITH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7050 ABBEY LOOP
Mailing Address - Street 2:
Mailing Address - City:COTTONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35453-4341
Mailing Address - Country:US
Mailing Address - Phone:205-886-5946
Mailing Address - Fax:
Practice Address - Street 1:7050 ABBEY LOOP
Practice Address - Street 2:
Practice Address - City:COTTONDALE
Practice Address - State:AL
Practice Address - Zip Code:35453-4341
Practice Address - Country:US
Practice Address - Phone:205-886-5946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL372600000X372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion