Healthcare Provider Details

I. General information

NPI: 1548263734
Provider Name (Legal Business Name): ROBERT MORRIS SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 AIRPORT BLVD
WEST COLUMBIA SC
29169-5016
US

IV. Provider business mailing address

1612 AIRPORT BLVD
WEST COLUMBIA SC
29169-5016
US

V. Phone/Fax

Practice location:
  • Phone: 803-380-6399
  • Fax: 877-484-7187
Mailing address:
  • Phone: 803-380-6399
  • Fax: 877-484-7187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21784
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: