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General NPI Number Information
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NPI Number | 1356675524
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Entity Type | Individual
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Provider Name | MR. WATLER GENE SMITH
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Gender | Male
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Dates
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Enumeration Date | 09/22/2009
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Last Update Date | 09/22/2009
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Provider Practice Location Address
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Address Line | 4526 US HIGHWAY 158
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City | OXFORD
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State | NC
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Zip | 27565-8480
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Country | US
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Telephone | 252-430-9885
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Fax | 919-339-4000
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Provider Business Mailing Address
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Address Line | 4526 US HIGHWAY 158
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City | OXFORD
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State | NC
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Zip | 27565-8480
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Country | US
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Telephone | 252-430-9885
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Fax | 919-339-4000
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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 | 171WH0202X
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Taxonomy Name | Home Modifications Contractor
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License Number | 22155-I
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License Number State | NC
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