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General NPI Number Information
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NPI Number | 1265952808
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Entity Type | Individual
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Provider Name | TIMOTHY PATRICK SMITH MS, RD, LDN
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Gender | Male
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Dates
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Enumeration Date | 06/25/2017
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Last Update Date | 08/03/2022
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Provider Practice Location Address
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Address Line | 630 DAVIDSON GATEWAY DRIVE, SUITE 150-I
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City | DAVIDSON
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State | NC
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Zip | 28036
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Country | US
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Telephone | 954-803-8533
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Fax | 704-664-9075
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Provider Business Mailing Address
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Address Line | 207 MADELIA PLACE
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City | MOORESVILLE
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State | NC
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Zip | 28115
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Country | US
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Telephone | 954-803-8533
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Fax | 704-664-9075
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | L005214
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License Number State | NC
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