Organization
SOUTHEASTERN RADIOLOGY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DALLAS AARON SMITH JR. MD (PRESIDENT)
(336) 852-3300
Entity
Organization
Contact information
Practice address
3801 W MARKET ST, GREENSBORO, NC 27407-1301
(336) 852-3300
(336) 852-0651
Mailing address
3801 W MARKET ST, GREENSBORO, NC 27407-1301
(336) 852-3300
(336) 852-0651
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
400555
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
890252K
—
NC
Enumeration date
06/09/2005
Last updated
12/08/2008
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