Individual
JORDAN C SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
701 GROVE RD FL 1, GREENVILLE, SC 29605-4210
(864) 455-7899
(864) 455-5474
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(803) 434-1335
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3880
SC
363AM0700X
Medical Physician Assistant
3664
TN
363AS0400X
Surgical Physician Assistant
3664
TN
Other
Enumeration date
07/18/2018
Last updated
09/03/2021
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