Provider Demographics
NPI:1619908951
Name:SMITH, CANDACE T (MD)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:T
Last Name:SMITH
Suffix:
Gender:F
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 14883
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27415-4883
Mailing Address - Country:US
Mailing Address - Phone:336-852-3800
Mailing Address - Fax:336-852-5725
Practice Address - Street 1:3511 W MARKET ST
Practice Address - Street 2:SUITE A
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-4443
Practice Address - Country:US
Practice Address - Phone:336-852-3800
Practice Address - Fax:336-852-5725
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33143207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8977267Medicaid
NC74263OtherMEDCOST
NC77267OtherBCBS OF NC
NC080117275Medicare PIN
NC77267OtherBCBS OF NC
NC74263OtherMEDCOST