Individual
HAYLEY JO SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.P.T.
Contact information
Practice address
3650 COALITION DR, MYRTLE BEACH, SC 29588-6183
(843) 293-7713
Mailing address
PO BOX 1145, MYRTLE BEACH, SC 29578-1145
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
5320
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP0242
—
SC
Enumeration date
10/06/2008
Last updated
10/06/2008
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