Provider Demographics
NPI:1336639483
Name:SMITH, MORGAN BRADFORD (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:MORGAN
Middle Name:BRADFORD
Last Name:SMITH
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2628 CAMELLIA DR APT A
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2054
Mailing Address - Country:US
Mailing Address - Phone:205-901-7269
Mailing Address - Fax:
Practice Address - Street 1:2503 E LYON STATION RD
Practice Address - Street 2:
Practice Address - City:CREEDMOOR
Practice Address - State:NC
Practice Address - Zip Code:27522-9112
Practice Address - Country:US
Practice Address - Phone:919-328-2581
Practice Address - Fax:919-528-8307
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5010524207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine