Provider Demographics
NPI:1336387281
Name:SMITH, GLORIA J
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 LIONSGATE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-6421
Mailing Address - Country:US
Mailing Address - Phone:803-261-6754
Mailing Address - Fax:803-736-7332
Practice Address - Street 1:177 LIONSGATE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6421
Practice Address - Country:US
Practice Address - Phone:803-261-6754
Practice Address - Fax:803-736-7332
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies