Healthcare Provider Details

I. General information

NPI: 1255328928
Provider Name (Legal Business Name): ALTHEA J SMILEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E WOOD ST
SPARTANBURG SC
29303-3040
US

IV. Provider business mailing address

150 BLUFF AVE
NORTH AUGUSTA SC
29841-3862
US

V. Phone/Fax

Practice location:
  • Phone: 864-560-6122
  • Fax: 864-560-6276
Mailing address:
  • Phone: 800-394-4445
  • Fax: 706-396-3252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number14689
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: