Provider Demographics
NPI:1477540466
Name:SMITH, JOHN JOSEPH III (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:SMITH
Suffix:III
Gender:M
Credentials:MD
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-564-4430
Mailing Address - Fax:336-277-1718
Practice Address - Street 1:2010 BALDWIN LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5846
Practice Address - Country:US
Practice Address - Phone:336-564-4430
Practice Address - Fax:336-277-1718
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-01208208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ0120DMedicaid
VA10385121Medicaid
4397049OtherAETNA
143A1OtherBCBS
MA6193161Medicaid
191377OtherMEDCOST
808464OtherPARTNERS
P00378870OtherRR MEDICARE
WV3810007318Medicaid
NC5905795Medicaid
WV3810007318Medicaid
MA6193161Medicaid
NCNC1724BMedicare PIN
191377OtherMEDCOST