Healthcare Provider Details

I. General information

NPI: 1972756609
Provider Name (Legal Business Name): ROY E. SMITH, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 03/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 MILL ST
CAMDEN SC
29020-3763
US

IV. Provider business mailing address

1111 MILL ST
CAMDEN SC
29020-3763
US

V. Phone/Fax

Practice location:
  • Phone: 803-425-1330
  • Fax: 803-425-1337
Mailing address:
  • Phone: 803-425-1330
  • Fax: 803-425-1337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number15151
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15151
License Number StateSC

VIII. Authorized Official

Name: MRS. KATHERINE LEE LANIER-SMITH
Title or Position: PRACTICE MANAGER
Credential: M.S.
Phone: 803-425-1330