Individual
MRS. MALLORY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
420 POLIFKA DR, SHAW AFB, SC 29152-5100
(803) 895-2273
Mailing address
420 POLIFKA DR, SHAW AFB, SC 29152-5100
(803) 895-6356
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
26148
SC
Other
Enumeration date
10/26/2022
Last updated
02/23/2026
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