Provider Demographics
NPI:1609666528
Name:SMITH, CHARLIE THOMAS
Entity type:Individual
Prefix:
First Name:CHARLIE
Middle Name:THOMAS
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 1:283 LEE THEE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-7931
Mailing Address - Country:US
Mailing Address - Phone:910-461-8615
Mailing Address - Fax:
Practice Address - Street 1:230 WAYMON CHAPEL RD
Practice Address - Street 2:
Practice Address - City:HAMLET
Practice Address - State:NC
Practice Address - Zip Code:28345-7124
Practice Address - Country:US
Practice Address - Phone:910-582-8637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18203173F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173F00000XOther Service ProvidersSleep Specialist, PhD