Healthcare Provider Details

I. General information

NPI: 1356545081
Provider Name (Legal Business Name): PHILLIP JOSHUA SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 HALTON VILLAGE CIR STE B
GREENVILLE SC
29607-6832
US

IV. Provider business mailing address

105 HALTON VILLAGE CIR STE B
GREENVILLE SC
29607-6832
US

V. Phone/Fax

Practice location:
  • Phone: 864-569-0126
  • Fax: 864-569-0175
Mailing address:
  • Phone: 864-569-0126
  • Fax: 864-569-0175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number40432
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number201200567
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number40432
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number201200567
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: