Provider Demographics
NPI:1811402951
Name:SMITH, JONATHAN ROWLAND
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ROWLAND
Last Name:SMITH
Suffix:
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 1:321 MULBERRY ST SW
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-5720
Mailing Address - Country:US
Mailing Address - Phone:828-757-5965
Mailing Address - Fax:828-757-5104
Practice Address - Street 1:322 MULBERRY ST SW STE C
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5703
Practice Address - Country:US
Practice Address - Phone:828-757-6464
Practice Address - Fax:828-757-6424
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant