Organization
FORT MILL DERMATOLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REBECCA LYNN SMITH MD (PRESIDENT)
(803) 802-3376
Entity
Organization
Contact information
Practice address
1700 FIRST BAXTER XING, STE 101, FORT MILL, SC 29708-8919
(803) 802-3376
(803) 802-3329
Mailing address
1700 FIRST BAXTER XING, STE 101, FORT MILL, SC 29708-8919
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
15514
SC
207N00000X
Dermatology Physician
29310
SC
207NP0225X
Pediatric Dermatology Physician
15514
SC
Other
Enumeration date
07/25/2006
Last updated
10/29/2007
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