Healthcare Provider Details

I. General information

NPI: 1801707518
Provider Name (Legal Business Name): CONNIE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 MIDWAY ST
BAMBERG SC
29003-1954
US

IV. Provider business mailing address

850 MIDWAY ST
BAMBERG SC
29003-1954
US

V. Phone/Fax

Practice location:
  • Phone: 803-747-2580
  • Fax:
Mailing address:
  • Phone: 803-747-2580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: