Individual
STACY LEE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 N FANT ST, ANDERSON, SC 29621-5708
(864) 512-1787
Mailing address
800 N FANT ST, ANDERSON, SC 29621-5708
(864) 512-1787
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
21115
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
211158
—
SC
Enumeration date
07/25/2006
Last updated
08/05/2008
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