Provider Demographics
NPI:1457504607
Name:SMITH, JOHN MORTON JR
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MORTON
Last Name:SMITH
Suffix:JR
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:PO BOX 3128
Mailing Address - Street 2:
Mailing Address - City:CASHIERS
Mailing Address - State:NC
Mailing Address - Zip Code:28717-3128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23 TENNIS COURT DR
Practice Address - Street 2:
Practice Address - City:CASHIERS
Practice Address - State:NC
Practice Address - Zip Code:28717
Practice Address - Country:US
Practice Address - Phone:828-743-2610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-01
Last Update Date:2008-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014754207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAEO1130Medicare UPIN