Healthcare Provider Details

I. General information

NPI: 1609834068
Provider Name (Legal Business Name): DAVID KEVIN SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 12/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 HOSPITAL DR STE 250
MT PLEASANT SC
29464
US

IV. Provider business mailing address

725 LONG POINT RD
MT PLEASANT SC
29464-8226
US

V. Phone/Fax

Practice location:
  • Phone: 843-971-8180
  • Fax: 843-971-9239
Mailing address:
  • Phone: 843-971-8180
  • Fax: 843-971-9239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number8893
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number8893
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: