Provider Demographics
NPI:1548834641
Name:B. SMITH & ASSOCIATES, LLC
Entity type:Organization
Organization Name:B. SMITH & ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:478-352-1025
Mailing Address - Street 1:PO BOX 6916
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31095-6916
Mailing Address - Country:US
Mailing Address - Phone:478-333-1232
Mailing Address - Fax:478-333-1368
Practice Address - Street 1:4501 RUSSELL PKWY STE 36
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-8681
Practice Address - Country:US
Practice Address - Phone:478-333-1232
Practice Address - Fax:478-333-1368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003249905BMedicaid