Provider Demographics
NPI:1083880835
Name:JOSEPH, SMITHA SARA (DPM)
Entity Type:Individual
Prefix:
First Name:SMITHA
Middle Name:SARA
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4015
Mailing Address - Country:US
Mailing Address - Phone:864-232-3668
Mailing Address - Fax:864-271-0526
Practice Address - Street 1:11 MILLS AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4015
Practice Address - Country:US
Practice Address - Phone:864-232-3668
Practice Address - Fax:864-271-0526
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC585213ES0103X
GAPOD001065213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA3228D593Medicare UPIN