Healthcare Provider Details

I. General information

NPI: 1104440635
Provider Name (Legal Business Name): COREY SMITH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 INNOVATION DR STE 400
GREENVILLE SC
29607-5270
US

IV. Provider business mailing address

4600 MCAULEY PL STE 600
BLUE ASH OH
45242-4778
US

V. Phone/Fax

Practice location:
  • Phone: 864-235-7665
  • Fax: 864-233-5971
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number95603
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11861
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: