Individual
ETHAN SMALLWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
222 E MEDICAL LN STE 101, WEST COLUMBIA, SC 29169-4850
(803) 739-3660
Mailing address
222 E MEDICAL LN STE 101, WEST COLUMBIA, SC 29169-4850
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
4903
SD
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/03/2023
Last updated
01/16/2024
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