Provider Demographics
NPI:1215513171
Name:SMITH, CHRISTOPHER CODY
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:CODY
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 472
Mailing Address - Street 2:
Mailing Address - City:BRADLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25818-0472
Mailing Address - Country:US
Mailing Address - Phone:681-422-2407
Mailing Address - Fax:
Practice Address - Street 1:238 VISCAYA DR
Practice Address - Street 2:
Practice Address - City:SHADY SPRING
Practice Address - State:WV
Practice Address - Zip Code:25918-1425
Practice Address - Country:US
Practice Address - Phone:681-422-2407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant