Healthcare Provider Details

I. General information

NPI: 1699034462
Provider Name (Legal Business Name): RONDELL ALEXIS SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2012
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 PINEYWOOD RD
THOMASVILLE NC
27360-3438
US

IV. Provider business mailing address

PO BOX 751803
CHARLOTTE NC
28275-1803
US

V. Phone/Fax

Practice location:
  • Phone: 336-475-8121
  • Fax:
Mailing address:
  • Phone: 336-475-8121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2015-00631
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: