Provider Demographics
NPI:1760642821
Name:SMITH, LAURA LEE (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:LEE
Other - Last Name:STUART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1670 DRY DOCK AVE
Mailing Address - Street 2:BUILDING 10: HARVEST FREE MEDICAL CLINIC
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-2114
Mailing Address - Country:US
Mailing Address - Phone:843-747-3526
Mailing Address - Fax:843-747-3527
Practice Address - Street 1:1670 DRY DOCK AVE
Practice Address - Street 2:BUILDING 10: HARVEST FREE MEDICAL CLINIC
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-2114
Practice Address - Country:US
Practice Address - Phone:843-747-3526
Practice Address - Fax:843-747-3527
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD 30822207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine