Provider Demographics
NPI:1639137102
Name:SMITH, JAMES S (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:S
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 1:203 COX BLVD
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534
Mailing Address - Country:US
Mailing Address - Phone:919-580-0000
Mailing Address - Fax:919-580-0209
Practice Address - Street 1:2410 MONTGOMERY DRIVE, SW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893
Practice Address - Country:US
Practice Address - Phone:252-293-0777
Practice Address - Fax:252-293-0888
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26759207RH0003X
NC9701156207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC267598Medicaid
NC267598Medicaid
NC2280244BOtherMEDICARE
SCP00365928OtherRAILROAD MEDICARE
NC2280244BOtherMEDICARE
SCH117078603Medicare PIN
H11707Medicare PIN
SC5880910001Medicare NSC