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NPI Code Detail

MEDICARE: DAIYSHA SMITH

MEDICARE: DAIYSHA SMITH
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
1207R00000XInternal Medicine Physician86398GA

General Provider Information

NPI Number : 1588167340
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAIYSHA SMITH
Provider Business Mailing Address
First Line : 1106 SAN ANTONIO BLVD
Second Line :
City : DURHAM
State : NC
Zip : 27703-8391
Country : US
Telephone Number : 919-264-2264
Fax Number :
Provider Business Practice Location Address
First Line : 1595 CLEVELAND AVE
Second Line :
City : EAST POINT
State : GA
Zip : 30344-3200
Country : US
Telephone Number : 919-264-2264
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2018
Last Update Date : 06/07/2023

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