Provider Demographics
NPI:1215997150
Name:SMITH, MEREDITH S (PA)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:S
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:2000 FRONTIS PLAZA BLVD STE 200
Mailing Address - Street 2:(ATTN) FORSYTH MEDICAL GROUP
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5616
Mailing Address - Country:US
Mailing Address - Phone:336-277-2435
Mailing Address - Fax:336-277-9275
Practice Address - Street 1:2001 TODAYS WOMAN AVE
Practice Address - Street 2:DBA TODAY'S WOMAN
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-5069
Practice Address - Country:US
Practice Address - Phone:336-722-1818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC103869363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2763659Medicare ID - Type Unspecified
NCQ45499Medicare UPIN