Provider Demographics
NPI:1609574409
Name:SMITH, MARCIA (MPA, BS, AAS)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MPA, BS, AAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 CLEGGAN RD APT 307
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-5879
Mailing Address - Country:US
Mailing Address - Phone:610-818-9863
Mailing Address - Fax:
Practice Address - Street 1:171 CLEGGAN RD APT 307
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-5879
Practice Address - Country:US
Practice Address - Phone:610-818-9863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor