Healthcare Provider Details

I. General information

NPI: 1215951652
Provider Name (Legal Business Name): SMITHVILLE CARDIOLOGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 E 9TH ST
SOUTHPORT NC
28461-3083
US

IV. Provider business mailing address

1900 RANDOLPH RD SUITE 500
CHARLOTTE NC
28207-1122
US

V. Phone/Fax

Practice location:
  • Phone: 910-457-9127
  • Fax: 910-457-5211
Mailing address:
  • Phone: 704-384-9679
  • Fax: 704-316-0508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JUAN ALDRICH
Title or Position: PRESIDENT
Credential: MD
Phone: 910-457-9127