Healthcare Provider Details

I. General information

NPI: 1952612871
Provider Name (Legal Business Name): KEYOKA SHEREE SMITH D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 09/01/2020
Certification Date: 08/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 N MAIN ST STE 202
COLUMBIA SC
29203-5800
US

IV. Provider business mailing address

10 SUMMERLEA LN
COLUMBIA SC
29203-3915
US

V. Phone/Fax

Practice location:
  • Phone: 803-570-2209
  • Fax: 888-866-4740
Mailing address:
  • Phone: 843-409-3201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD001211
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number65 006369
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number622
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: