Healthcare Provider Details

I. General information

NPI: 1750676524
Provider Name (Legal Business Name): JAMES HAYWOOD SMITH JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 01/26/2022
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 DOUG WHITE DR STE 460
MYRTLE BEACH SC
29572-4182
US

IV. Provider business mailing address

920 DOUG WHITE DR STE 460
MYRTLE BEACH SC
29572-4182
US

V. Phone/Fax

Practice location:
  • Phone: 843-449-2336
  • Fax: 843-497-0625
Mailing address:
  • Phone: 843-449-2336
  • Fax: 843-497-0625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number51588
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number83970
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier7100253080
Identifier TypeMEDICAID
Identifier StateKY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: