Individual
WILLIE W SMITH III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1521 MAPLEWOOD AVE, RONCEVERTE, WV 24970-8026
(304) 647-5642
(304) 793-5643
Mailing address
176 DAWKINS DR, LEWISBURG, WV 24901-9302
(304) 647-4411
(304) 793-5643
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
01526
WV
Other
Enumeration date
09/11/2013
Last updated
09/16/2020
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