Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 1987 | SC |
NPI | 1487880191 |
---|---|
Provider Name | Dr. Deena Fawn Smith |
First Address | Folly Beach, SC 29439 |
Second Address | Folly Beach, SC 29439 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2009 |
Last Update Date | 09/06/2009 |