Provider Demographics
NPI:1003974171
Name:LAKE MURRAY OBGYN
Entity Type:Organization
Organization Name:LAKE MURRAY OBGYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITHSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-996-5550
Mailing Address - Street 1:1404 W MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-2332
Mailing Address - Country:US
Mailing Address - Phone:803-996-5550
Mailing Address - Fax:
Practice Address - Street 1:1404 W MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-2332
Practice Address - Country:US
Practice Address - Phone:803-996-5550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty