=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164646451
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNE JOHNSON SMITHSON M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3800 HILLSBOROUGH STREET CARROLL HEALTH CENTER
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27607-5298
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-760-8535
-----------------------------------------------------
Fax | 919-760-8534
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 103 SOLITUDE WAY
-----------------------------------------------------
City | CARY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27518
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-859-1533
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 95-00453
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------