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Organization
BETWEEN THE LAKES FAMILY PRACTICE, PA
Active
Organization
BETWEEN THE LAKES FAMILY PRACTICE, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL MOUZON SMITH JR. M.D. (PRESIDENT)
(864) 888-4445
Entity
Organization
Contact information
Practice address
106 RAM CAT ALY, SENECA, SC 29678-3244
(864) 888-4445
(864) 888-4345
Mailing address
106 RAM CAT ALY, SENECA, SC 29678-3244
(864) 888-4445
(864) 888-4345
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP3282
—
SC
Enumeration date
01/31/2006
Last updated
08/22/2020
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