Provider Demographics
NPI:1982698387
Name:SMITH, WILLIAM PHILLIP (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PHILLIP
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 STONE AVE
Mailing Address - Street 2:
Mailing Address - City:TALLADEGA
Mailing Address - State:AL
Mailing Address - Zip Code:35160-2219
Mailing Address - Country:US
Mailing Address - Phone:256-362-1410
Mailing Address - Fax:256-362-0186
Practice Address - Street 1:724 STONE AVE
Practice Address - Street 2:
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160-2219
Practice Address - Country:US
Practice Address - Phone:256-362-1410
Practice Address - Fax:256-362-0186
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2023-03-07
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
AL9293207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL9293OtherSTATE MEDICAL LICENSE
AL529904160Medicaid
AL529904160Medicaid
AL529904160Medicaid