Carolyn Denise Smith

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

157882 Issued in OR

Practice address

1046 6TH Ave SW
Albany, OR 97321-1916

Phone

(910) 520-3869

NPI assigned

Jan 13, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1642032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642032000000",
    "number": "1104577956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1046 6TH AVE SW",
            "city": "ALBANY",
            "state": "OR",
            "postal_code": "973211916",
            "telephone_number": "910-520-3869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1046 6TH AVE SW",
            "city": "ALBANY",
            "state": "OR",
            "postal_code": "973211916",
            "telephone_number": "910-520-3869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "CAROLYN",
        "middle_name": "DENISE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-13",
        "last_updated": "2022-01-13",
        "certification_date": "2022-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OR",
            "license": "157882",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "csmith@samhealt.org",
            "affiliation": "N",
            "address_1": "4053 NW Oak Grove Dr",
            "city": "Albany",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973219361",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "csmith@samhealth.org",
            "affiliation": "N",
            "address_1": "4053 NW Oak Grove Dr",
            "city": "Albany",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973219361",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Smiles on 9TH LLC
• Julie Smircic, LCSW
• Connie Amanda Smith-Wells, MSW
• Angela Smith
• Ashlyn Smith, PHARMD
• Daniel Raven Smith
• Ellery Qwin Smith
• Kassandra Smith, DPT, PT
• Latoya Smith
• Tonia Rose Smith, LMT #15083

• Surgery Physician in Albany, OR
• Providers in Albany, OR by specialty
• Surgery Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.