Provider Demographics
NPI:1912673658
Name:JAMES A. SMITH MD PEDIATRICS
Entity Type:Organization
Organization Name:JAMES A. SMITH MD PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:WADDELL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:704-614-3401
Mailing Address - Street 1:925 THOMAS ST STE B
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-3484
Mailing Address - Country:US
Mailing Address - Phone:704-871-8588
Mailing Address - Fax:704-871-8452
Practice Address - Street 1:925 THOMAS ST STE B
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3484
Practice Address - Country:US
Practice Address - Phone:704-871-8588
Practice Address - Fax:704-871-8452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-22
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty