Provider Demographics
NPI:1588379135
Name:SMITH, GARY ARNIZE JR
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:ARNIZE
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4408 BRANDON LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-4931
Mailing Address - Country:US
Mailing Address - Phone:586-343-4558
Mailing Address - Fax:
Practice Address - Street 1:4408 BRANDON LN
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-4931
Practice Address - Country:US
Practice Address - Phone:586-343-4558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant