Provider Demographics
NPI:1831328343
Name:SMITH, AMANDA KEITH (MD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:KEITH
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TERRI
Other - Middle Name:AMANDA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:22394 MIFLIN RD STE 203
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-9593
Mailing Address - Country:US
Mailing Address - Phone:251-943-3622
Mailing Address - Fax:251-943-3683
Practice Address - Street 1:22394 MIFLIN RD STE 203
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-9593
Practice Address - Country:US
Practice Address - Phone:251-943-3622
Practice Address - Fax:251-943-3683
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.36306207Q00000X
MS22128207Q00000X
FLME127674207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL213949Medicaid
FL017317000Medicaid