Provider Demographics
NPI:1992744916
Name:SMITH, AMOS HEDRICK JR (CRNA)
Entity type:Individual
Prefix:MR
First Name:AMOS
Middle Name:HEDRICK
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 INDIAN WELLS CIR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27295-8670
Mailing Address - Country:US
Mailing Address - Phone:336-956-1488
Mailing Address - Fax:
Practice Address - Street 1:301 INDIAN WELLS CIR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27295-8670
Practice Address - Country:US
Practice Address - Phone:336-956-1488
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC059385367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8050155Medicaid
NC2618154BMedicare ID - Type Unspecified