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General NPI Number Information
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NPI Number | 1073323341
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Entity Type | Individual
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Provider Name | MADISON SMITH
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Gender | Female
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Dates
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Enumeration Date | 01/09/2025
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 612 MOCKSVILLE AVE
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City | SALISBURY
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State | NC
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Zip | 28144-2732
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Country | US
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Telephone | 704-210-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 11909 MOURNING DOVE LN
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City | CHARLOTTE
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State | NC
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Zip | 28269-0674
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-15019
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License Number State | NC
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