Healthcare Provider Details

I. General information

NPI: 1346213485
Provider Name (Legal Business Name): ERIN E.W. SMITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8120 ROURK ST
MYRTLE BEACH SC
29572
US

IV. Provider business mailing address

8120 ROURK ST
MYRTLE BEACH SC
29572-4127
US

V. Phone/Fax

Practice location:
  • Phone: 843-449-1438
  • Fax: 843-286-1349
Mailing address:
  • Phone: 843-449-1438
  • Fax: 843-286-1349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number30228
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: