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General NPI Number Information
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NPI Number | 1669922969
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Entity Type | Individual
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Provider Name | JUSTIN TAYLOR SMITH MD
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Gender | Male
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Dates
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Enumeration Date | 10/11/2016
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Last Update Date | 12/26/2025
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Provider Practice Location Address
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Address Line | 3225B REIDVILLE RD
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City | SPARTANBURG
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State | SC
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Zip | 29301-6120
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Country | US
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Telephone | 803-220-4207
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 77862
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City | CHARLOTTE
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State | NC
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Zip | 28271-7019
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Country | US
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Telephone | 803-220-4207
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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 | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 85638
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 2022-01292
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License Number State | NC
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