Healthcare Provider Details

I. General information

NPI: 1790617496
Provider Name (Legal Business Name): SMITH MEDICAL CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 HIGHMARKET STREET
GEORGETOWN SC
29440
US

IV. Provider business mailing address

99 BASKERVILL DRIVE
PAWLEYS ISLAND SC
29585
US

V. Phone/Fax

Practice location:
  • Phone: 843-237-2672
  • Fax:
Mailing address:
  • Phone: 843-237-2672
  • Fax: 843-237-0369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANNE M FAUL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 843-237-2672