Healthcare Provider Details

I. General information

NPI: 1407890932
Provider Name (Legal Business Name): REBECCA STARR SMITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 W GEORGIA RD SUITE B
SIMPSONVILLE SC
29680-6419
US

IV. Provider business mailing address

300 E MCBEE AVE STE 401
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-454-5000
  • Fax: 864-454-5005
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23175
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: