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General NPI Number Information
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NPI Number | 1437613171
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Entity Type | Organization
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Legal Business Name | SME SOUTH CAROLINA P.C.
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Dates
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Enumeration Date | 01/28/2019
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Last Update Date | 02/25/2019
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Provider Practice Location Address
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Address Line | 212 CAPE AUGUST PL
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City | BELMONT
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State | NC
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Zip | 28012-6768
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Country | US
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Telephone | 704-300-3884
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Fax |
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Provider Business Mailing Address
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Address Line | 4321 COLLINGTON RD
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City | BOWIE
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State | MD
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Zip | 20716-2259
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Country | US
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Telephone | 704-300-3884
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ENDIA JOHNSON-PITTS
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Credential | MD
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Telephone | 704-300-3884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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