=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497618722
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASON SMITH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2025
-----------------------------------------------------
Last Update Date | 12/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 817 PUTNEY HILL RD
-----------------------------------------------------
City | ZEBULON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27597-5551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-487-9634
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 817 PUTNEY HILL RD
-----------------------------------------------------
City | ZEBULON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27597-5551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-487-9634
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 342000000X
-----------------------------------------------------
Taxonomy Name | Transportation Network Company
-----------------------------------------------------
License Number | 24227716
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------