Organization
BETWEEN THE LAKES FAMILY PRACTICE, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL MOUZON SMITH JR. M.D. (PRESIDENT)
(864) 888-4445
Entity
Organization
Contact information
Practice address
106 RAM CAT ALY, SENECA, SC 29678-3244
(864) 888-4445
(864) 888-4345
Mailing address
106 RAM CAT ALY, SENECA, SC 29678-3244
(864) 888-4445
(864) 888-4345
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP3282
—
SC
Enumeration date
01/31/2006
Last updated
08/22/2020
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