Healthcare Provider Details

I. General information

NPI: 1902995111
Provider Name (Legal Business Name): TONYA DEE SMITH LITTLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3724 RALEIGH ROAD PKWY W
WILSON NC
27896-9742
US

IV. Provider business mailing address

3724 RALEIGH ROAD PKWY W
WILSON NC
27896-9742
US

V. Phone/Fax

Practice location:
  • Phone: 252-246-8840
  • Fax: 252-246-8841
Mailing address:
  • Phone: 252-246-8890
  • Fax: 252-246-8848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number97-01464
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: