Provider Demographics
NPI:1841978632
Name:SMITH, WILLIAM EDWARD III
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:EDWARD
Last Name:SMITH
Suffix:III
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 1:1032 GELFIELD RD
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-6820
Mailing Address - Country:US
Mailing Address - Phone:919-798-5083
Mailing Address - Fax:
Practice Address - Street 1:1032 GELFIELD RD
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-6820
Practice Address - Country:US
Practice Address - Phone:919-798-5083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28812616172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver