MEDICARE: GREGORY SMITH FNP-BC

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	363LF0000X	Family Nurse Practitioner	71010511A	IN
2	363LF0000X	Family Nurse Practitioner	21993	SC
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	21993	SC

General Provider Information

NPI Number	:	1699253294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY SMITH FNP-BC

Provider Business Mailing Address
First Line	:	3505 PELHAM RD STE B
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-4154
Country	:	US
Telephone Number	:	864-551-8022
Fax Number	:	864-412-1003

Provider Business Practice Location Address
First Line	:	3505 PELHAM RD STE B
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-4154
Country	:	US
Telephone Number	:	864-551-8022
Fax Number	:	864-412-1003

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

Provider Enumeration Date	:	08/06/2018
Last Update Date	:	07/02/2025

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