Provider Demographics
NPI:1386827335
Name:PIEDMONT NEONATOLOGY PC
Entity Type:Organization
Organization Name:PIEDMONT NEONATOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MCCRAE
Authorized Official - Middle Name:S
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-478-1016
Mailing Address - Street 1:628 GREEN VALLEY ROAD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7789
Mailing Address - Country:US
Mailing Address - Phone:336-478-1016
Mailing Address - Fax:336-851-1737
Practice Address - Street 1:628 GREEN VALLEY ROAD
Practice Address - Street 2:SUITE 210
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7789
Practice Address - Country:US
Practice Address - Phone:336-478-1016
Practice Address - Fax:336-851-1737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5908644Medicaid