Healthcare Provider Details

I. General information

NPI: 1154714053
Provider Name (Legal Business Name): CHRIS JOHN SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2015
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S KINGS DR STE G
CHARLOTTE NC
28204-3089
US

IV. Provider business mailing address

931 JEFFERSON BLVD STE 2001
WARWICK RI
02886-2245
US

V. Phone/Fax

Practice location:
  • Phone: 704-333-9055
  • Fax:
Mailing address:
  • Phone: 401-773-2711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1422
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: