Basic Information
| Provider Information | |||||||||
| NPI: | 1619908951 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | CANDACE | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 14883 | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274154883 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368523800 | ||||||||
| FaxNumber: | 3368525725 | ||||||||
| Practice Location | |||||||||
| Address1: | 3511 W MARKET ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274034443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368523800 | ||||||||
| FaxNumber: | 3368525725 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 04/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 33143 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8977267 | 05 | NC | MEDICAID | 74263 | 01 | NC | MEDCOST | OTHER | 77267 | 01 | NC | BCBS OF NC | OTHER |