=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093270803
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BOYD SETH SMITH PA-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2019
-----------------------------------------------------
Last Update Date | 05/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3021 REIDVILLE RD
-----------------------------------------------------
City | SPARTANBURG
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29301-5643
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-576-9201
-----------------------------------------------------
Fax | 864-576-6584
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3021 REIDVILLE RD
-----------------------------------------------------
City | SPARTANBURG
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29301-5643
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-576-9201
-----------------------------------------------------
Fax | 864-576-6584
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 3144
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------