Provider Demographics
NPI:1194578484
Name:SMITH, REAGAN PAISLEY
Entity type:Individual
Prefix:
First Name:REAGAN
Middle Name:PAISLEY
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16550 PARKER RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-8538
Mailing Address - Country:US
Mailing Address - Phone:256-998-0670
Mailing Address - Fax:
Practice Address - Street 1:3966 ATLANTA HWY STE 375
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36109-2919
Practice Address - Country:US
Practice Address - Phone:185-583-2672
Practice Address - Fax:772-675-9100
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician