Healthcare Provider Details

I. General information

NPI: 1093551012
Provider Name (Legal Business Name): SILVERSMITH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2024
Last Update Date: 07/09/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 REVOLUTION MILL DR STE 10
GREENSBORO NC
27405-5067
US

IV. Provider business mailing address

1705 BICKETT BLVD
RALEIGH NC
27608-2543
US

V. Phone/Fax

Practice location:
  • Phone: 817-271-5728
  • Fax:
Mailing address:
  • Phone: 817-271-5728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVE NEORR
Title or Position: MANAGING MEMBER
Credential: MBA
Phone: 817-271-5728