Healthcare Provider Details

I. General information

NPI: 1215930664
Provider Name (Legal Business Name): ALAN KENNETH SMITH AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BROADBENT WAY
ANDERSON SC
29625
US

IV. Provider business mailing address

101 BROADBENT WAY
ANDERSON SC
29625
US

V. Phone/Fax

Practice location:
  • Phone: 864-222-0059
  • Fax: 864-222-9008
Mailing address:
  • Phone: 864-222-0059
  • Fax: 864-222-9008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2405
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: