Provider Demographics
NPI:1578684924
Name:SMITH, GREGORY WARREN (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:WARREN
Last Name:SMITH
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 1:151 CENTURY DR APT 109E
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-1529
Mailing Address - Country:US
Mailing Address - Phone:864-626-7601
Mailing Address - Fax:864-241-1049
Practice Address - Street 1:975 W FARIS RD
Practice Address - Street 2:NEW HORIZON FAMILY HEALTH SERVICES
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4241
Practice Address - Country:US
Practice Address - Phone:864-729-8330
Practice Address - Fax:864-751-0479
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC332512084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA26939OtherMEDICAL LICENSE
SC33251OtherMEDICAL LICENSE
SC33251OtherMEDICAL LICENSE
GA26939OtherMEDICAL LICENSE