Healthcare Provider Details

I. General information

NPI: 1740614064
Provider Name (Legal Business Name): ANDREW PAUL IRWIN-SMILER PHD, MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ANDREW PAUL SMILER PHD, MA

II. Dates (important events)

Enumeration Date: 08/22/2013
Last Update Date: 08/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 BRIARCLIFF ROAD
WINSTON-SALEM NC
27106
US

IV. Provider business mailing address

2910 BRIARCLIFF ROAD
WINSTON-SALEM NC
27106
US

V. Phone/Fax

Practice location:
  • Phone: 336-245-8161
  • Fax: 336-773-0332
Mailing address:
  • Phone: 336-245-8161
  • Fax: 336-773-0332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberAPPLICANT
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: