Individual
MR. DERRICK LAVON SMITH JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4420 LAKE BOONE TRL, RALEIGH, NC 27607-7505
(919) 784-3100
Mailing address
4420 LAKE BOONE TRL, RALEIGH, NC 27607-7505
(704) 340-7223
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-13504
NC
Other
Enumeration date
09/22/2023
Last updated
02/19/2024
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