1235842014 NPI number — DR. LEWIS THOMAS GODBEE SMITH III DC

Table of content: DR. LEWIS THOMAS GODBEE SMITH III DC (NPI 1235842014)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235842014 NPI number — DR. LEWIS THOMAS GODBEE SMITH III DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
LEWIS
Provider Middle Name:
THOMAS GODBEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
DC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMITH
Provider Other First Name:
TREY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1235842014
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8158 STATE HIGHWAY 59 APT 106
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOLEY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36535-3881
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-943-0569
Provider Business Mailing Address Fax Number:
251-322-1811

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8158 STATE HIGHWAY 59 APT 106
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOLEY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36535-3881
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-943-0569
Provider Business Practice Location Address Fax Number:
251-322-1811
Provider Enumeration Date:
12/27/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2775 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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