Provider Demographics
NPI:1780782805
Name:SMITH, JEAN CHARLOTTE (MD)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:CHARLOTTE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:JEAN
Other - Middle Name:CHARLOTTE
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10 SUNNYBROOK RD
Mailing Address - Street 2:WAKE COUNTY HUMAN SERVICES
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1808
Mailing Address - Country:US
Mailing Address - Phone:919-250-4483
Mailing Address - Fax:919-212-8399
Practice Address - Street 1:10 SUNNYBROOK ROAD
Practice Address - Street 2:WAKE COUNTY HUMAN SERVICES
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1808
Practice Address - Country:US
Practice Address - Phone:919-250-4483
Practice Address - Fax:919-212-8399
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC279762080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8977831Medicaid