Healthcare Provider Details

I. General information

NPI: 1033112164
Provider Name (Legal Business Name): KAREN LINNEAR SMITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date: 03/15/2006
Reactivation Date: 03/21/2006

III. Provider practice location address

929 WEST PROSPECT AVE.
RAEFORD NC
28376
US

IV. Provider business mailing address

929 WEST PROSPECT AVE.
RAEFORD NC
28376
US

V. Phone/Fax

Practice location:
  • Phone: 910-904-1695
  • Fax: 910-904-1767
Mailing address:
  • Phone: 910-904-1695
  • Fax: 910-904-1767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33894
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: