Healthcare Provider Details

I. General information

NPI: 1063775195
Provider Name (Legal Business Name): ANDREW BAIN SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W 8TH NORTH ST STE B
SUMMERVILLE SC
29483-6656
US

IV. Provider business mailing address

PO BOX 751649
CHARLOTTE NC
28275-1649
US

V. Phone/Fax

Practice location:
  • Phone: 844-975-6683
  • Fax: 843-606-8056
Mailing address:
  • Phone: 888-472-0043
  • Fax: 843-724-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number87479
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: