Provider Demographics
NPI:1528121092
Name:SMITH, JAMES
Entity type:Individual
Prefix:MR
First Name:JAMES
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 1:3827 CHARBONNETT CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-4900
Mailing Address - Country:US
Mailing Address - Phone:614-579-5966
Mailing Address - Fax:614-759-8584
Practice Address - Street 1:3827 CHARBONNETT CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4900
Practice Address - Country:US
Practice Address - Phone:614-579-5966
Practice Address - Fax:614-759-8584
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2180705374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2180705OtherINDEPENDENT PROVIDER