Provider Demographics
NPI:1356675524
Name:SMITH, WATLER GENE
Entity Type:Individual
Prefix:MR
First Name:WATLER
Middle Name:GENE
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4526 US HIGHWAY 158
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-8480
Mailing Address - Country:US
Mailing Address - Phone:252-430-9885
Mailing Address - Fax:919-339-4000
Practice Address - Street 1:4526 US HIGHWAY 158
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-8480
Practice Address - Country:US
Practice Address - Phone:252-430-9885
Practice Address - Fax:919-339-4000
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22155-I171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications