=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336639483
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MORGAN BRADFORD SMITH FNP-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2018
-----------------------------------------------------
Last Update Date | 05/15/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2503 E LYON STATION RD
-----------------------------------------------------
City | CREEDMOOR
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27522-9112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-328-2581
-----------------------------------------------------
Fax | 919-528-8307
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2628 CAMELLIA DR APT A
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27705-2054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-901-7269
-----------------------------------------------------
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 | 5010524
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------