Provider Demographics
NPI:1447315080
Name:SMITH, MICHAEL EARL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EARL
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 CONFERENCE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5971
Mailing Address - Country:US
Mailing Address - Phone:252-756-4899
Mailing Address - Fax:252-756-5141
Practice Address - Street 1:925 CONFERENCE DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5971
Practice Address - Country:US
Practice Address - Phone:252-756-4899
Practice Address - Fax:252-756-5141
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC357552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC77978OtherBC BS PROVIDER NUMBER
NC8977978Medicaid
NC2184050CMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NCF53804Medicare UPIN