Provider Demographics
NPI:1649248576
Name:CARSON, LEE SMITH (MD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:SMITH
Last Name:CARSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:MRS
Other - First Name:LEE
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:645-228-6118
Mailing Address - Fax:
Practice Address - Street 1:9 RICHLAND MEDICAL PARK DR STE 450
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6859
Practice Address - Country:US
Practice Address - Phone:803-434-6155
Practice Address - Fax:803-434-3855
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22975207NP0225X, 207R00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8616OtherMEDICARE GROUP PIN FOR NE DERMATOLOGY
SCT70900Medicaid
SC8616OtherMEDICARE GROUP PIN FOR NE DERMATOLOGY
H534912003Medicare ID - Type Unspecified
SCH534912003Medicare PIN
H534917004Medicare ID - Type UnspecifiedTEACHING CLINICS
SCH53491Medicare UPIN
SCH534917004Medicare PIN