Healthcare Provider Details

I. General information

NPI: 1851431928
Provider Name (Legal Business Name): WILSON P SMITH JR MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 06/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 NORTH CHURCH PLACE
SPARTANBURG SC
29303-2706
US

IV. Provider business mailing address

PO BOX 4276
SPARTANBURG SC
29305-4276
US

V. Phone/Fax

Practice location:
  • Phone: 864-582-6858
  • Fax: 864-585-0999
Mailing address:
  • Phone: 864-582-6858
  • Fax: 864-585-0999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number10510
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number10510
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number10510
License Number StateSC

VIII. Authorized Official

Name: MS. DARLA M BROWN
Title or Position: OFFICE MANAGER
Credential: RRT
Phone: 864-582-6858