Provider Demographics
NPI:1982283628
Name:SMITH, PERCY
Entity Type:Individual
Prefix:
First Name:PERCY
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:WV
Mailing Address - Zip Code:25126-0007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 SMITH LANE
Practice Address - Street 2:
Practice Address - City:LOUDON
Practice Address - State:WV
Practice Address - Zip Code:25126
Practice Address - Country:US
Practice Address - Phone:410-800-6497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker