MEDICARE: ANDREW BAIN SMITH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080S0010X	Pediatric Sports Medicine Physician	87479	SC

General Provider Information

NPI Number	:	1063775195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW BAIN SMITH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 751649
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1649
Country	:	US
Telephone Number	:	888-472-0043
Fax Number	:	843-724-2440

Provider Business Practice Location Address
First Line	:	102 W 8TH NORTH ST STE B
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-6656
Country	:	US
Telephone Number	:	844-975-6683
Fax Number	:	843-606-8056

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2012
Last Update Date	:	08/01/2025

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