MEDICARE: CLAUDE WILSON SMITH MD

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	174400000X	Specialist	7673	SC

General Provider Information

NPI Number	:	1922079144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAUDE WILSON SMITH MD

Provider Business Mailing Address
First Line	:	2750 LAUREL ST
Second Line	:	SUITE 305
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2038
Country	:	US
Telephone Number	:	803-254-5140
Fax Number	:	803-779-1279

Provider Business Practice Location Address
First Line	:	2750 LAUREL ST
Second Line	:	SUITE 305
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2038
Country	:	US
Telephone Number	:	803-254-5140
Fax Number	:	803-779-1279

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

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	07/08/2007

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