Provider Demographics
NPI:1437613171
Name:SME SOUTH CAROLINA P.C.
Entity Type:Organization
Organization Name:SME SOUTH CAROLINA P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ENDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON-PITTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-300-3884
Mailing Address - Street 1:4321 COLLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-2259
Mailing Address - Country:US
Mailing Address - Phone:704-300-3884
Mailing Address - Fax:
Practice Address - Street 1:212 CAPE AUGUST PL
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-6768
Practice Address - Country:US
Practice Address - Phone:704-300-3884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-28
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty