MEDICARE: SUNTIA SMITH LLC

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	1041C0700X	Clinical Social Worker	9166	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649654997
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNTIA SMITH LLC

Provider Business Mailing Address
First Line	:	3445 PELHAM RD STE B
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-4194
Country	:	US
Telephone Number	:	864-559-8581
Fax Number	:	864-751-9331

Provider Business Practice Location Address
First Line	:	3445 PELHAM RD STE B
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-4194
Country	:	US
Telephone Number	:	864-559-8581
Fax Number	:	864-751-9331

Authorized Official
Title or Position	:	OWNER
Name	:	SUNTIA SMITH
Credential	:
Telephone Number	:	864-444-3057

Provider Enumeration Date	:	07/16/2015
Last Update Date	:	10/01/2015

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Directions to “SUNTIA SMITH LLC ” Practice Location

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