Healthcare Provider Details

I. General information

NPI: 1831153402
Provider Name (Legal Business Name): EASTERN CAROLINA EAR NOSE AND THROAT ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 10/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 NORTH BRIGHT LEAF BLVD
SMITHFIELD NC
27577
US

IV. Provider business mailing address

PO BOX 571
SMITHFIELD NC
27577-0571
US

V. Phone/Fax

Practice location:
  • Phone: 919-934-0948
  • Fax: 919-934-0193
Mailing address:
  • Phone: 919-934-0948
  • Fax: 919-934-0193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number31119
License Number StateNC

VIII. Authorized Official

Name: MRS. DAWN YVONNE SMITH
Title or Position: OFFICE MANAGER
Credential:
Phone: 919-934-0948