Basic Information
| Provider Information | |||||||||
| NPI: | 1447315080 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | EARL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 925 CONFERENCE DR | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278585971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2527564899 | ||||||||
| FaxNumber: | 2527565141 | ||||||||
| Practice Location | |||||||||
| Address1: | 925 CONFERENCE DR | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278585971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2527564899 | ||||||||
| FaxNumber: | 2527565141 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 35755 | NC | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 77978 | 01 | NC | BC BS PROVIDER NUMBER | OTHER | 8977978 | 05 | NC | MEDICAID |