Healthcare Provider Details

I. General information

NPI: 1609792654
Provider Name (Legal Business Name): NATHANIEL JAMAL SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 E 3RD ST
WINSTON SALEM NC
27101-4604
US

IV. Provider business mailing address

1904 E 3RD ST
WINSTON SALEM NC
27101-4604
US

V. Phone/Fax

Practice location:
  • Phone: 336-692-9532
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: