Individual
AMANDA MARIE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
701 GROVE RD FL 1, GREENVILLE, SC 29605-4210
(864) 455-7899
(864) 455-5474
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
5151014294
MI
207P00000X
Emergency Medicine Physician
Primary
89511
SC
363A00000X
Physician Assistant
10001302A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300017039
—
IN
Enumeration date
07/29/2011
Last updated
08/29/2024
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