Provider Demographics
NPI:1306455670
Name:SMITH, WETAWNYA (CPM, LM)
Entity type:Individual
Prefix:
First Name:WETAWNYA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5188 US HIGHWAY 278 W
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35057-1404
Mailing Address - Country:US
Mailing Address - Phone:256-339-7287
Mailing Address - Fax:
Practice Address - Street 1:5188 US HIGHWAY 278 W
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35057-1404
Practice Address - Country:US
Practice Address - Phone:256-339-7287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0012176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife