Provider Demographics
NPI:1386603934
Name:SMULL, DAVID L (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:SMULL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 14TH AVE SE STE 100
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-3326
Mailing Address - Country:US
Mailing Address - Phone:256-351-0688
Mailing Address - Fax:256-265-1633
Practice Address - Street 1:1107 14TH AVE SE STE 100
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3326
Practice Address - Country:US
Practice Address - Phone:256-351-0688
Practice Address - Fax:256-265-1633
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO.3720207RC0000X, 207RA0001X
NC2002-00286207RC0000X
FLOS16292207RA0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant CardiologyGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLLN948OtherMEDICARE
FL103960800Medicaid
NC8913088Medicaid
NC13088OtherBCBS ID#
FLLN948OtherMEDICARE
NC1285682310OtherWSCA GRP NPI #
NC13088OtherBCBS ID#
NC8913088Medicaid
VA1386603934Medicaid
NC2401244BMedicare PIN