Healthcare Provider Details

I. General information

NPI: 1275917049
Provider Name (Legal Business Name): PATRICIA SMITH MT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2015
Last Update Date: 07/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 W 2ND NORTH ST
SUMMERVILLE SC
29483-6538
US

IV. Provider business mailing address

308 W 2ND NORTH ST
SUMMERVILLE SC
29483-6538
US

V. Phone/Fax

Practice location:
  • Phone: 843-851-1905
  • Fax:
Mailing address:
  • Phone: 843-851-1905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: