Healthcare Provider Details

I. General information

NPI: 1033150222
Provider Name (Legal Business Name): JAMES ADAM SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 S SHIRLEY AVE
HONEA PATH SC
29654-1503
US

IV. Provider business mailing address

PO BOX 100174
COLUMBIA SC
29202-3174
US

V. Phone/Fax

Practice location:
  • Phone: 864-512-7879
  • Fax: 864-512-7037
Mailing address:
  • Phone: 864-512-7879
  • Fax: 864-512-7037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10895
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: