Healthcare Provider Details

I. General information

NPI: 1700826328
Provider Name (Legal Business Name): RONALD KENNETH SMITH SR. PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 W MARKET ST
GREENSBORO NC
27407-1301
US

IV. Provider business mailing address

645 N MAIN ST
HIGH POINT NC
27260-5017
US

V. Phone/Fax

Practice location:
  • Phone: 336-883-0029
  • Fax:
Mailing address:
  • Phone: 336-883-0029
  • Fax: 336-899-2176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-01842
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: