Healthcare Provider Details

I. General information

NPI: 1649435546
Provider Name (Legal Business Name): ANGELA BILLUPS SMITH R.D., L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3604 FERNANDINA RD SUITE 204
COLUMBIA SC
29210-5221
US

IV. Provider business mailing address

266 CHARLWOOD RD
IRMO SC
29063-2303
US

V. Phone/Fax

Practice location:
  • Phone: 803-414-3696
  • Fax:
Mailing address:
  • Phone: 803-414-3696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number890432
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number462
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: