Healthcare Provider Details

I. General information

NPI: 1275857294
Provider Name (Legal Business Name): EASTERN PHYSICAL MEDICINE & REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2010
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2245 STANTONSBURG RD STE A
GREENVILLE NC
27834-2868
US

IV. Provider business mailing address

2245 STANTONSBURG RD STE A
GREENVILLE NC
27834-2868
US

V. Phone/Fax

Practice location:
  • Phone: 252-215-9294
  • Fax: 252-215-9279
Mailing address:
  • Phone: 252-215-9294
  • Fax: 252-215-9279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number200200604
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: BILLY RAY SMITH
Title or Position: OWNER
Credential: MD
Phone: 252-215-9294