Individual
DR. MIMI CHAMBLIN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2022 BROOKWOOD MEDICAL CTR DR, SUITE 313 ACC, BIRMINGHAM, AL 35209-6808
(205) 877-2910
(205) 879-4649
Mailing address
2022 BROOKWOOD MEDICAL CTR DR, SUITE 313 ACC, BIRMINGHAM, AL 35209-6808
(205) 877-2910
(205) 879-4649
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
22700
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009985905
—
AL
01
—
1750341756
NPI
AL
01
—
1922068774
GROUP NPI
AL
01
—
51000823
BLUE CROSS BLUE SHIELD
AL
01
—
63-0677675
FEDERAL TAX ID
AL
Enumeration date
03/24/2006
Last updated
04/10/2014
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