Provider Demographics
NPI:1225097496
Name:SMITH, TIMOTHY TED (DO)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:TED
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 BEAMAN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-2602
Mailing Address - Country:US
Mailing Address - Phone:910-596-0093
Mailing Address - Fax:910-596-2287
Practice Address - Street 1:522 BEAMAN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2602
Practice Address - Country:US
Practice Address - Phone:910-596-0093
Practice Address - Fax:910-596-2287
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9401340207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine