Healthcare Provider Details

I. General information

NPI: 1922116250
Provider Name (Legal Business Name): CAROLYN L HARRAWAY-SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLYN LORAINE HARRAWAY MD

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 3RD ST
GREENSBORO NC
27405-6967
US

IV. Provider business mailing address

930 3RD ST
GREENSBORO NC
27405-6967
US

V. Phone/Fax

Practice location:
  • Phone: 336-890-3200
  • Fax: 336-890-3290
Mailing address:
  • Phone: 336-890-3200
  • Fax: 336-890-3290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD0056011
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number41905
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2013-00964
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: