Provider Demographics
NPI:1215566682
Name:ROCKHOLT-SMITH, TONI JOHNETTE (DO)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:JOHNETTE
Last Name:ROCKHOLT-SMITH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TONI
Other - Middle Name:JOHNETTE
Other - Last Name:ROCKHOLT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1320 RIBAUT RD
Mailing Address - Street 2:
Mailing Address - City:PORT ROYAL
Mailing Address - State:SC
Mailing Address - Zip Code:29935-1118
Mailing Address - Country:US
Mailing Address - Phone:505-272-5551
Mailing Address - Fax:843-986-0900
Practice Address - Street 1:719 OKATIE HWY # 170
Practice Address - Street 2:
Practice Address - City:OKATIE
Practice Address - State:SC
Practice Address - Zip Code:29909-3963
Practice Address - Country:US
Practice Address - Phone:843-987-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2023-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM390200000X
SC89683208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program