Provider Demographics
NPI:1497771760
Name:SMITH, JAMES ANDERSON (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ANDERSON
Last Name:SMITH
Suffix:
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:704-384-1050
Mailing Address - Fax:704-384-1051
Practice Address - Street 1:1918 RANDOLPH RD
Practice Address - Street 2:SUITE 175
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1100
Practice Address - Country:US
Practice Address - Phone:704-316-1050
Practice Address - Fax:704-316-1051
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32044207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN32044Medicaid
NC8977961Medicaid
NC204094LMedicare ID - Type Unspecified
NC8977961Medicaid