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NPI 1255752762

NPI 1255752762 : ADAM SMITH MS, LAT, ATC : BELMONT, NC

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General NPI Number Information
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    NPI Number           |    1255752762
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    Entity Type          |    Individual 
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    Provider Name        |    ADAM SMITH MS, LAT, ATC
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    12/31/2013
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    Last Update Date     |    12/31/2013
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Provider Practice Location Address
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    Address Line         |    100 BELMONT MOUNT HOLLY RD 
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    City                 |    BELMONT
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    State                |    NC
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    Zip                  |    28012-2702
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    Country              |    US
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    Telephone            |    704-461-6265
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    8509 ETHERTON CT 
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    City                 |    CHARLOTTE
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    State                |    NC
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    Zip                  |    28216-1671
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    Country              |    US
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    Telephone            |    704-616-1653
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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        |    2255A2300X
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    Taxonomy Name        |    Athletic Trainer
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    License Number       |    1331
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    License Number State |    NC
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