Provider Demographics
NPI:1417908393
Name:SMYTHE, ALEXANDER R (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:R
Last Name:SMYTHE
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 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-296-7320
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:1301 TAYLOR ST STE 6J
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2930
Practice Address - Country:US
Practice Address - Phone:803-296-2942
Practice Address - Fax:803-779-9581
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6701207V00000X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCUSC001Medicaid
SC067019Medicaid
SCUSC001Medicaid
SCB92235Medicare UPIN
SCUSC001Medicaid
SC6129Medicare ID - Type Unspecified