Healthcare Provider Details

I. General information

NPI: 1609666528
Provider Name (Legal Business Name): CHARLIE THOMAS SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 WAYMON CHAPEL RD
HAMLET NC
28345-7124
US

IV. Provider business mailing address

283 LEE THEE CHURCH RD
ROCKINGHAM NC
28379-7931
US

V. Phone/Fax

Practice location:
  • Phone: 910-582-8637
  • Fax:
Mailing address:
  • Phone: 910-461-8615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173F00000X
TaxonomySleep Specialist (PhD)
License Number18203
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: