Provider Demographics
NPI:1295111656
Name:SMITH FAMILY CLINIC FOR GENOMIC MEDICINE LLC
Entity type:Organization
Organization Name:SMITH FAMILY CLINIC FOR GENOMIC MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL OPERATIONS ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:AIKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-327-9640
Mailing Address - Street 1:701 MCMILLIAN WAY NW
Mailing Address - Street 2:SUITE A
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-2922
Mailing Address - Country:US
Mailing Address - Phone:256-327-9640
Mailing Address - Fax:
Practice Address - Street 1:701 MCMILLIAN WAY NW
Practice Address - Street 2:SUITE A
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-2922
Practice Address - Country:US
Practice Address - Phone:256-327-9640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-07
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty