Individual
TYLER MARIE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
96 JONATHAN LUCAS ST, CHARLESTON, SC 29425-8900
(404) 277-6303
Mailing address
96 JONATHAN LUCAS ST, CSB 816; MSC 630, CHARLESTON, SC 29425-8900
(404) 277-6303
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
6040
SC
363A00000X
Physician Assistant
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
02/13/2024
Last updated
02/20/2026
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