MEDICARE: EMMALEIGH MADELINE SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	2011-00991	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487812889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMALEIGH MADELINE SMITH

Provider Business Mailing Address
First Line	:	6387 RAMSEY ST UNIT 100
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28311-9442
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6387 RAMSEY ST UNIT 100
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28311-9442
Country	:	US
Telephone Number	:	910-615-3879
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2008
Last Update Date	:	08/24/2021

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