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General NPI Number Information
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NPI Number | 1114601218
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Entity Type | Individual
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Provider Name | TIM W SMITH
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Gender | Male
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 02/06/2024
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Provider Practice Location Address
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Address Line | 190 INDEPENDENCE DR
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City | ROEBUCK
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State | SC
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Zip | 29376-3335
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Country | US
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Telephone | 812-457-5367
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Fax |
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Provider Business Mailing Address
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Address Line | 933 PINE LOG RD # 1068
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City | AIKEN
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State | SC
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Zip | 29803-7330
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number |
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License Number State |
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