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Individual

MR. MARION JACKSON SMITH III

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
4500 8TH DIVISION RD, COLUMBIA, SC 29207-5700
(803) 751-6789
Mailing address
4575 STUART STREET, COLUMBIA, SC 29207
(803) 751-6789

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1073896

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1073896
NCCPA CERTIFICATE #
01
PA4340
SOUTH CAROLINA LICENSE NUMBER
SC
Enumeration date
02/20/2007
Last updated
07/16/2025
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