Healthcare Provider Details

I. General information

NPI: 1750376067
Provider Name (Legal Business Name): NATALIE D. DEPCIK-SMITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 GREEN VALLEY RD SUITE 104
GREENSBORO NC
27408-7038
US

IV. Provider business mailing address

PO BOX 13508
GREENSBORO NC
27415-3508
US

V. Phone/Fax

Practice location:
  • Phone: 336-271-4930
  • Fax: 336-271-8466
Mailing address:
  • Phone: 336-271-4930
  • Fax: 336-271-8466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: