Individual
CHARLIE DORN SMITH III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2322 BURNT BRANCH RD, LAKE CITY, SC 29560-7910
(843) 687-0153
(843) 673-9457
Mailing address
2322 BURNT BRANCH RD, LAKE CITY, SC 29560-7910
(843) 687-0153
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
13042
SC
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
2023-01615
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
130423
—
SC
01
—
1679530968
GROUP NPI
SC
01
—
7937
MEDICARE GROUP NUMBER
SC
Enumeration date
05/02/2006
Last updated
12/15/2025
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