MEDICARE: DR. STANTON JAMES SMITH M.D.

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	2084P0800X	Psychiatry Physician	33309	NC
2	2084P0804X	Child & Adolescent Psychiatry Physician	33309	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679546451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STANTON JAMES SMITH M.D.

Provider Business Mailing Address
First Line	:	350 PEE DEE AVE
Second Line	:	SUITE A
City	:	ALBEMARLE
State	:	NC
Zip	:	28001-4932
Country	:	US
Telephone Number	:	704-986-1500
Fax Number	:

Provider Business Practice Location Address
First Line	:	5113 PIPER STATION DR
Second Line	:	SUITE 207
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-6689
Country	:	US
Telephone Number	:	704-541-5200
Fax Number	:

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

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	03/03/2014

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