Provider Demographics
NPI:1871161646
Name:SMITH, SHIRLEY A (CNA)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 81
Mailing Address - Street 2:
Mailing Address - City:CHILDERSBURG
Mailing Address - State:AL
Mailing Address - Zip Code:35044-0081
Mailing Address - Country:US
Mailing Address - Phone:202-059-9744
Mailing Address - Fax:
Practice Address - Street 1:152 SADIE LEE HOMES
Practice Address - Street 2:
Practice Address - City:CHILDERSBURG
Practice Address - State:AL
Practice Address - Zip Code:35044-1536
Practice Address - Country:US
Practice Address - Phone:205-997-4430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health