Individual
THYLLIS GARDENIA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
339 RAMSEUR JULIAN RD, RAMSEUR, NC 27316
(336) 402-5592
(336) 643-0693
Mailing address
PO BOX 1165, RAMSEUR, NC 27316
(336) 402-5592
(336) 643-0693
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3408719
—
NC
05
—
8301180
—
NC
Enumeration date
02/09/2007
Last updated
07/08/2007
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