Individual
KATINA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
179 RACE TRACK LN, HAYNEVILLE, AL 36040-2045
(334) 300-4176
Mailing address
179 RACE TRACK LN, HAYNEVILLE, AL 36040-2045
(334) 300-4176
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
6350020
AL
Other
Enumeration date
02/26/2019
Last updated
02/26/2019
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