Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Stacy Douglas Smith, ATC

Individual provider Athletic Trainer · NPI 1912262148

Mr. Stacy Douglas Smith, ATC is an Athletic Trainer in Newark, New Jersey. Practices as a sole proprietor. Licensed in New Jersey.

Licensed in
NJ
In the registry since
2012
What do these letters mean?
ATC — Certified Athletic Trainer
Prevents and treats sport and activity injuries.

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Practice location Address checks out

80 Johnson Ave Shabazz
Newark, NJ 07108
Phone: (973) 744-4113
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Athletic Trainer (primary) Taxonomy 2255A2300X · Licence 25MT00037500 (NJ)

Record details

NPI number1912262148
Entity typeIndividual (Type 1)
GenderMale
Credentials ATC
Sole proprietorYes
NPI enumeratedJuly 13, 2012
Last updated in NPPESJune 14, 2016

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