Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 15151 | SC |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 15151 | SC |
NPI | 1245287291 |
---|---|
Provider Name | Roy E Smith |
First Address | Camden, SC 29020-3703 |
Second Address | Camden, SC 29020-3703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 25/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
151515 | (05) | SC |
E74734 | (02) | SC |