MEDICARE: JOSHUA SMITH MS, ATC, MHS, PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0010-04522	NC
2	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1245267269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA SMITH MS, ATC, MHS, PA-C

Provider Business Mailing Address
First Line	:	5213 S ALSTON AVE
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-4430
Country	:	US
Telephone Number	:	919-684-8111
Fax Number	:

Provider Business Practice Location Address
First Line	:	3480 WAKE FOREST RD STE 208
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-7376
Country	:	US
Telephone Number	:	919-781-4541
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	04/22/2022

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