Healthcare Provider Details

I. General information

NPI: 1801456207
Provider Name (Legal Business Name): KELSEY ANNE SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 GROVE RD FL 1
GREENVILLE SC
29605-4210
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-455-7899
  • Fax: 864-455-5474
Mailing address:
  • Phone: 803-434-6485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number82726
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: