Healthcare Provider Details

I. General information

NPI: 1346275260
Provider Name (Legal Business Name): BILLY RAY SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 11/28/2018
Certification Date:
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 TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number200200604
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: