Healthcare Provider Details

I. General information

NPI: 1386827335
Provider Name (Legal Business Name): PIEDMONT NEONATOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 GREEN VALLEY ROAD SUITE 210
GREENSBORO NC
27408-7789
US

IV. Provider business mailing address

628 GREEN VALLEY ROAD SUITE 210
GREENSBORO NC
27408-7789
US

V. Phone/Fax

Practice location:
  • Phone: 336-478-1016
  • Fax: 336-851-1737
Mailing address:
  • Phone: 336-478-1016
  • Fax: 336-851-1737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MCCRAE S SMITH
Title or Position: PRESIDENT
Credential: MD
Phone: 336-478-1016