Provider Demographics
NPI:1003935792
Name:SMITH, GEORGE PATRICK
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:PATRICK
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E CHEVES ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2526
Mailing Address - Country:US
Mailing Address - Phone:843-317-4089
Mailing Address - Fax:843-317-4096
Practice Address - Street 1:730 S DARGAN ST
Practice Address - Street 2:APT 4-D
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2563
Practice Address - Country:US
Practice Address - Phone:843-661-4718
Practice Address - Fax:843-661-4722
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC376241Medicaid
SC376241Medicaid