Glennis Dale Smith, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA709 Issued in AL

Practice address

5300 57TH St N
Birmingham, AL 35217-3328

Phone

(205) 808-3220

NPI assigned

Jun 1, 2010

Last updated

Jun 1, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1275350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1275350400000",
    "number": "1023337037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 SCOTTSDALE DR",
            "city": "ALABASTER",
            "state": "AL",
            "postal_code": "350078994",
            "telephone_number": "205-685-9777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5300 57TH ST N",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352173328",
            "telephone_number": "205-808-3220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "GLENNIS",
        "middle_name": "DALE",
        "name_prefix": "Mr.",
        "credential": "P.A.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-06-01",
        "last_updated": "2010-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AL",
            "license": "PA709",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erin A Smith, CRNA
• Erin Greer Smith, OTD, OTR/L
• Frances Elizabeth Smith, CRNP
• Frederick B Smith, DMD
• Glennie Scott Smith, CRNA
• Grant Dellinger Smith
• Haller Jackson Smith, M.D.
• Hannah Leopard Smith, CRNP
• James A. Smith Jr., D.M.D.
• James C. Smith, CRNA

• Physician Assistant in Birmingham, AL
• Providers in Birmingham, AL by specialty
• Physician Assistant in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.