Individual
MR. STACY DOUGLAS SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
A.T.,C
Contact information
Practice address
80 JOHNSON AVE, SHABAZZ, NEWARK, NJ 07108
(973) 744-4113
Mailing address
80 JOHNSON AVE, SHABAZZ, NEWARK, NJ 07108
(973) 744-4113
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
25MT00037500
NJ
Other
Enumeration date
07/13/2012
Last updated
06/14/2016
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