Individual
DR. WILSON P SMITH JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2030 N CHURCH PLACE, SPARTANBURG, SC 29303-2796
(864) 582-6858
(864) 585-0999
Mailing address
PO BOX 4276, SPARTANBURG, SC 29305-4276
(864) 582-6858
(864) 585-0999
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
10510
SC
207RP1001X
Pulmonary Disease Physician
10510
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105102
—
SC
01
—
290009757
RAILROAD
SC
01
—
8688
MBPG'S
SC
Enumeration date
01/31/2006
Last updated
12/21/2015
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