Provider Demographics
NPI:1992152284
Name:SMITH, MARILYN DYER
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:DYER
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 MCFARLAND BLVD N
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2138
Mailing Address - Country:US
Mailing Address - Phone:205-556-5541
Mailing Address - Fax:205-554-7937
Practice Address - Street 1:1850 MCFARLAND BLVD N
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2138
Practice Address - Country:US
Practice Address - Phone:205-556-5541
Practice Address - Fax:205-554-7937
Is Sole Proprietor?:No
Enumeration Date:2016-05-17
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-097380363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily