Provider Demographics
NPI:1104898634
Name:SMITH, MICHAEL ALSON (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALSON
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 1:305 W CATAWBA AVE
Mailing Address - Street 2:PO BOX 786
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NC
Mailing Address - Zip Code:28120
Mailing Address - Country:US
Mailing Address - Phone:704-822-6200
Mailing Address - Fax:704-822-1601
Practice Address - Street 1:305 W CATAWBA AVE
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NC
Practice Address - Zip Code:28120
Practice Address - Country:US
Practice Address - Phone:704-822-6200
Practice Address - Fax:704-822-1601
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33467207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1104898634OtherNPI
NC5950360Medicaid
NC1104898634OtherNPI
NC5950360Medicaid
NCBS3025308OtherDEA
NCXS3025308OtherDEA