1780782805 NPI number — DR. JEAN CHARLOTTE SMITH MD

Table of content: DR. JEAN CHARLOTTE SMITH MD (NPI 1780782805)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780782805 NPI number — DR. JEAN CHARLOTTE SMITH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
JEAN
Provider Middle Name:
CHARLOTTE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HALL
Provider Other First Name:
JEAN
Provider Other Middle Name:
CHARLOTTE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1780782805
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 SUNNYBROOK RD
Provider Second Line Business Mailing Address:
WAKE COUNTY HUMAN SERVICES
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27610-1808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-250-4483
Provider Business Mailing Address Fax Number:
919-212-8399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 SUNNYBROOK ROAD
Provider Second Line Business Practice Location Address:
WAKE COUNTY HUMAN SERVICES
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27610-1808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-250-4483
Provider Business Practice Location Address Fax Number:
919-212-8399
Provider Enumeration Date:
09/20/2006

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: 2080P0006X , with the licence number:  27976 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8977831 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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