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NPI Code Detail

MEDICARE: DR. GREGORY WARREN SMITH M.D.

MEDICARE: DR. GREGORY WARREN 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
12084P0800XPsychiatry Physician33251SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
126939OTHERGAMEDICAL LICENSE
233251OTHERSCMEDICAL LICENSE

General Provider Information

NPI Number : 1578684924
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GREGORY WARREN SMITH M.D.
Provider Business Mailing Address
First Line : 151 CENTURY DR APT 109E
Second Line :
City : GREENVILLE
State : SC
Zip : 29607-1529
Country : US
Telephone Number : 864-626-7601
Fax Number : 864-241-1049
Provider Business Practice Location Address
First Line : 975 W FARIS RD
Second Line : NEW HORIZON FAMILY HEALTH SERVICES
City : GREENVILLE
State : SC
Zip : 29605-4241
Country : US
Telephone Number : 864-729-8330
Fax Number : 864-751-0479
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2007
Last Update Date : 08/12/2016

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