Healthcare Provider Details

I. General information

NPI: 1942636295
Provider Name (Legal Business Name): JOSEPH F. SMITH PSYCHIATRY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2013
Last Update Date: 09/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4346 STARKEY RD SUITE 1
ROANOKE VA
24018-0605
US

IV. Provider business mailing address

4346 STARKEY RD SUITE 1
ROANOKE VA
24018-0605
US

V. Phone/Fax

Practice location:
  • Phone: 540-772-8043
  • Fax: 540-772-8242
Mailing address:
  • Phone: 540-772-8043
  • Fax: 540-772-8242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number0101043204
License Number StateVA

VIII. Authorized Official

Name: DR. JOSEPH F SMITH
Title or Position: OWNER
Credential: MD
Phone: 540-772-8043