Basic Information
| Provider Information | |||||||||
| NPI: | 1518986652 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMART | ||||||||
| FirstName: | CARL | ||||||||
| MiddleName: | ANDRE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60447 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282600447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043162154 | ||||||||
| FaxNumber: | 7043162159 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 WELLNESS BLVD | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | MONROE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281103354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043162154 | ||||||||
| FaxNumber: | 7043162159 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 10/25/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 9400640 | NC | N | Other Service Providers | Specialist | 207RP1001X | 9400640 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | N00640 | 05 | SC | MEDICAID | 8977165 | 05 | NC | MEDICAID |