Healthcare Provider Details

I. General information

NPI: 1669902805
Provider Name (Legal Business Name): PATRICIA BETHANY SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2017
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1879 SAVAGE RD
CHARLESTON SC
29407-4726
US

IV. Provider business mailing address

PO BOX 632516
CINCINNATI OH
45263-2516
US

V. Phone/Fax

Practice location:
  • Phone: 843-763-9472
  • Fax: 843-763-7411
Mailing address:
  • Phone: 888-472-0043
  • Fax: 513-653-4122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number51191
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number51191
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLL51191
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: