Individual
CHRISTINA DICARLO SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
35 RAY E TALLEY CT, SIMPSONVILLE, SC 29680-6772
(864) 967-7028
Mailing address
PO BOX 749306, ATLANTA, GA 30374-9306
(678) 986-7500
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1969
SC
363A00000X
Physician Assistant
TL1969
SC
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1709PA
—
SC
Enumeration date
07/18/2013
Last updated
11/11/2024
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