Active NPI
Timothy Patrick Smith, MS, RD, LDN
- Registered Dietitian
- Davidson, NC
National Provider Identifier
1265952808
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- L005214
- Practice address
- 630 Davidson Gateway Drive, Suite 150-I
Davidson, NC 28036 - Phone
- (954) 803-8533
- Fax
- (704) 664-9075
- NPI assigned
- Jun 25, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | L005214 | NC | Primary |
Addresses
Primary practice location
630 Davidson Gateway Drive, Suite 150-I
Davidson, NC 28036
Mailing address
207 Madelia Place
Mooresville, NC 28115
Phone (954) 803-8533
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L005214 | NC | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498348800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1659484800000",
"number": "1265952808",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "207 MADELIA PLACE",
"city": "MOORESVILLE",
"state": "NC",
"postal_code": "28115",
"telephone_number": "954-803-8533",
"fax_number": "704-664-9075"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "630 DAVIDSON GATEWAY DRIVE, SUITE 150-I",
"city": "DAVIDSON",
"state": "NC",
"postal_code": "28036",
"telephone_number": "954-803-8533",
"fax_number": "704-664-9075"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "TIMOTHY",
"middle_name": "PATRICK",
"name_prefix": "Mr.",
"credential": "MS, RD, LDN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-06-25",
"last_updated": "2022-08-03",
"certification_date": "2022-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NC",
"license": "L005214",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Davidson, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 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.