Provider Demographics
NPI:1356519706
Name:SMITH, ERNEST TERRILL (PA-C)
Entity type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:TERRILL
Last Name:SMITH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27260-5017
Mailing Address - Country:US
Mailing Address - Phone:336-883-0002
Mailing Address - Fax:
Practice Address - Street 1:108 W MAIN ST STE E
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NC
Practice Address - Zip Code:27282-9812
Practice Address - Country:US
Practice Address - Phone:336-883-0029
Practice Address - Fax:336-883-0867
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC363A00000X
NC001001278363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2762092Medicare PIN