Provider Demographics
NPI:1316454283
Name:SMITH, JOHN
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
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 1:365 MALACCA ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44305-3659
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:339 E GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-3850
Practice Address - Country:US
Practice Address - Phone:330-957-4599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-02
Last Update Date:2024-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSM821261172A00000X
1744G0900X, 251V00000X, 344600000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No172A00000XOther Service ProvidersDriver
No1744G0900XOther Service ProvidersSpecialistGraphics Designer
No251V00000XAgenciesVoluntary or Charitable
No344600000XTransportation ServicesTaxi