Healthcare Provider Details

I. General information

NPI: 1467068445
Provider Name (Legal Business Name): KHALIF SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 ANDREWS RD STE 130
DURHAM NC
27705-2993
US

IV. Provider business mailing address

2029 GRAY GOOSE LOOP
FAYETTEVILLE NC
28306-3583
US

V. Phone/Fax

Practice location:
  • Phone: 919-682-5777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: