Provider Demographics
NPI:1104892124
Name:SMITH, ANDREW AUGUSTUS (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:AUGUSTUS
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:27961 HIGHWAY 98
Mailing Address - Street 2:STE 14
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-4725
Mailing Address - Country:US
Mailing Address - Phone:251-626-1175
Mailing Address - Fax:251-625-1507
Practice Address - Street 1:27961 HIGHWAY 98
Practice Address - Street 2:STE 14
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4725
Practice Address - Country:US
Practice Address - Phone:251-626-1175
Practice Address - Fax:251-625-1507
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
AL20172207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G38756Medicare UPIN