Provider Demographics
NPI:1376636969
Name:SMITH, JEFFREY W II (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:W
Last Name:SMITH
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:115 N SUMTER ST
Mailing Address - Street 2:305
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4972
Mailing Address - Country:US
Mailing Address - Phone:803-938-5663
Mailing Address - Fax:803-339-1984
Practice Address - Street 1:115 N SUMTER ST
Practice Address - Street 2:305
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4972
Practice Address - Country:US
Practice Address - Phone:803-546-2886
Practice Address - Fax:803-339-1984
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC791207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC007913Medicaid
SC007913Medicaid