Healthcare Provider Details

I. General information

NPI: 1326020793
Provider Name (Legal Business Name): NANCY L SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 BOWMAN GRAY DR
GREENVILLE NC
27834-7215
US

IV. Provider business mailing address

2515 BOWMAN GRAY DR
GREENVILLE NC
27834-7215
US

V. Phone/Fax

Practice location:
  • Phone: 252-561-7992
  • Fax: 252-561-7993
Mailing address:
  • Phone: 252-561-7992
  • Fax: 252-561-7993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number9601479
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: