Provider Demographics
NPI:1265490684
Name:NESSMITH, MATTHEW G (MD)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:G
Last Name:NESSMITH
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 1:2 INNOVATION DRIVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5261
Mailing Address - Country:US
Mailing Address - Phone:864-235-7665
Mailing Address - Fax:864-282-2069
Practice Address - Street 1:2 INNOVATION DRIVE
Practice Address - Street 2:SUITE 400
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5261
Practice Address - Country:US
Practice Address - Phone:864-235-7665
Practice Address - Fax:864-282-2069
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30442207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA484874888AMedicaid
GA06BDJFQMedicare PIN
GAB92010Medicare UPIN
SC8157Medicare PIN