Individual
MR. BRENT TIMOTHY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
151 RIBAULT STREET SUITE 200, SPARTANBURG, SC 29302
(864) 237-7674
Mailing address
151 RIBAULT STREET SUITE 200, SPARTANBURG, SC 29302
(864) 237-7674
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
NATABOC #120702076
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DOES NOT APPLY TO AT
NONE
SC
Enumeration date
08/31/2016
Last updated
08/31/2016
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