Provider Demographics
NPI:1356545081
Name:SMITH, PHILLIP JOSHUA (MD)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:JOSHUA
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:105 HALTON VILLAGE CIR STE B
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-6832
Mailing Address - Country:US
Mailing Address - Phone:864-569-0126
Mailing Address - Fax:864-569-0175
Practice Address - Street 1:105 HALTON VILLAGE CIR STE B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6832
Practice Address - Country:US
Practice Address - Phone:864-569-0126
Practice Address - Fax:864-569-0175
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC40432207LP2900X, 208VP0014X
NC201200567207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC6832AMedicare PIN