Provider Demographics
NPI:1972550283
Name:SMITH, SCOTT WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:WILLIAM
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 1:990 LAKE HUNTER CIR STE 101
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-5426
Mailing Address - Country:US
Mailing Address - Phone:843-972-8136
Mailing Address - Fax:843-972-8163
Practice Address - Street 1:990 LAKE HUNTER CIR STE 101
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-5426
Practice Address - Country:US
Practice Address - Phone:843-972-8136
Practice Address - Fax:843-972-8163
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16211207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCL13082Medicaid
SCL13082Medicaid
SCF299851124Medicare PIN
SCSC85379223Medicare PIN