Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 585 | SC |
N | 213ES0103X | Foot & Ankle Surgery | POD001065 | GA |
NPI | 1083880835 |
---|---|
Provider Name | Smitha Sara Joseph |
First Address | Greenville, SC 29605-4015 |
Second Address | Greenville, SC 29605-4015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2008 |
Last Update Date | 17/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AA3228D593 | (02) | SC |