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Organization
OPEN WATER MEDICAL, PA
Active
Organization
OPEN WATER MEDICAL, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TISHA RAE SMITH (PRACTICE MANAGER)
(252) 728-5737
Entity
Organization
Contact information
Practice address
11 OFFICE PARK DR, JACKSONVILLE, NC 28546-7326
(910) 353-9906
(910) 353-4853
Mailing address
1620C LIVE OAK ST, BEAUFORT, NC 28516-1583
(252) 728-5737
(252) 728-5739
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1750482493
—
NC
Enumeration date
04/29/2022
Last updated
04/29/2022
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