Individual
MRS. CAROLYN NICOLE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4278 LADSON RD, LADSON, SC 29456-5452
(843) 203-2240
(843) 203-2241
Mailing address
PO BOX 751649, CHARLOTTE, NC 28275-1649
(843) 789-1620
(843) 724-2440
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2121
SC
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01182369
AMERIGROUP
GA
05
—
2782PA
—
SC
05
—
510115972A
—
GA
Enumeration date
12/06/2006
Last updated
10/29/2020
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