Provider Demographics
NPI:1518922509
Name:SMITH-PHILLIPS, STEPHANIE E (M)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:E
Last Name:SMITH-PHILLIPS
Suffix:
Gender:F
Credentials:M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 LONG POINT RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7930
Mailing Address - Country:US
Mailing Address - Phone:843-881-0320
Mailing Address - Fax:843-881-5453
Practice Address - Street 1:570 LONG POINT RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7930
Practice Address - Country:US
Practice Address - Phone:843-881-0320
Practice Address - Fax:843-881-5453
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10896207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC108966Medicaid
SCD470897818OtherMEDICARE INDIVIDUAL PTAN
SC10896OtherSC INDIVIDUAL MEDICAL LICENSE