Provider Demographics
NPI:1740347004
Name:SMITH, ANTHONY J (PHD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:J
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:6015 FAYETTEVILLE RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6254
Mailing Address - Country:US
Mailing Address - Phone:919-957-7357
Mailing Address - Fax:919-957-9539
Practice Address - Street 1:6015 FAYETTEVILLE STREET
Practice Address - Street 2:SUITE 114
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713
Practice Address - Country:US
Practice Address - Phone:919-957-7357
Practice Address - Fax:919-957-9539
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2606103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000210Medicaid