Healthcare Provider Details

I. General information

NPI: 1669442927
Provider Name (Legal Business Name): DANIEL MOUZON SMITH JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 11/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 KEOWEE SCHOOL RD SENECA
SENECA SC
29672-6743
US

IV. Provider business mailing address

1 INDEPENDENCE PT GREENVILLE
GREENVILLE SC
29615-4545
US

V. Phone/Fax

Practice location:
  • Phone: 864-885-7129
  • Fax: 864-882-7240
Mailing address:
  • Phone: 864-797-6044
  • Fax: 864-797-6198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number18070
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: