Healthcare Provider Details

I. General information

NPI: 1497618722
Provider Name (Legal Business Name): JASON SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 PUTNEY HILL RD
ZEBULON NC
27597-5551
US

IV. Provider business mailing address

817 PUTNEY HILL RD
ZEBULON NC
27597-5551
US

V. Phone/Fax

Practice location:
  • Phone: 833-487-9634
  • Fax:
Mailing address:
  • Phone: 833-487-9634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number24227716
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: