Healthcare Provider Details

I. General information

NPI: 1871238980
Provider Name (Legal Business Name): CALEB AMOS SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 05/18/2025
Certification Date: 05/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 MAIN ST
PROSPECT HILL NC
27314-9438
US

IV. Provider business mailing address

590 MANNING DR
CHAPEL HILL NC
27599-6119
US

V. Phone/Fax

Practice location:
  • Phone: 336-562-3311
  • Fax:
Mailing address:
  • Phone: 984-974-0210
  • Fax: 919-966-6216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRTL22-0213
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2025-01221
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: