Provider Demographics
NPI:1033150222
Name:SMITH, JAMES ADAM (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ADAM
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100174
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-3174
Mailing Address - Country:US
Mailing Address - Phone:864-512-7879
Mailing Address - Fax:864-512-7037
Practice Address - Street 1:21 S SHIRLEY AVE
Practice Address - Street 2:
Practice Address - City:HONEA PATH
Practice Address - State:SC
Practice Address - Zip Code:29654-1503
Practice Address - Country:US
Practice Address - Phone:864-512-7879
Practice Address - Fax:864-512-7037
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10895207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC108957Medicaid
SC108957Medicaid
E351556608Medicare ID - Type Unspecified
SC6608Medicare PIN