Healthcare Provider Details

I. General information

NPI: 1144880436
Provider Name (Legal Business Name): SMART PERSON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 E CHESTNUT ST
ASHEVILLE NC
28801-2330
US

IV. Provider business mailing address

191 E CHESTNUT ST
ASHEVILLE NC
28801-2330
US

V. Phone/Fax

Practice location:
  • Phone: 913-948-1340
  • Fax:
Mailing address:
  • Phone: 913-948-1340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHAWN L WILLSON
Title or Position: OWNER
Credential: MD
Phone: 913-948-1340