Provider Demographics
NPI:1649435546
Name:SMITH, ANGELA BILLUPS (RD, LD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:BILLUPS
Last Name:SMITH
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 CHARLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2303
Mailing Address - Country:US
Mailing Address - Phone:803-414-3696
Mailing Address - Fax:
Practice Address - Street 1:3604 FERNANDINA RD
Practice Address - Street 2:SUITE 204
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-5221
Practice Address - Country:US
Practice Address - Phone:803-414-3696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC890432133V00000X
SC462133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric