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
1209 E ASH ST, GOLDSBORO, NC 27530-5103
(919) 734-9455
(919) 734-4769
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
—
—
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
12/28/2018
Last updated
02/24/2022
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