Provider Demographics
NPI:1740247972
Name:SMITH, GREGORY C (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:C
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 100523
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-0523
Mailing Address - Country:US
Mailing Address - Phone:843-669-5162
Mailing Address - Fax:843-667-4573
Practice Address - Street 1:1000 W HAMLET AVE
Practice Address - Street 2:RADIOLOGY DEPT
Practice Address - City:HAMLET
Practice Address - State:NC
Practice Address - Zip Code:28345-4522
Practice Address - Country:US
Practice Address - Phone:843-669-5162
Practice Address - Fax:843-667-4573
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC386912085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC944274OtherDESERET MUTUAL
SCG49673Medicaid
NC611473300OtherUS DEPT OF LABOR
NC1230KOtherBCBS OF NC
NC5902965Medicaid
NC203824712OtherSTANDARD TAX ID
NC2147714BMedicare PIN
NCP00296333Medicare ID - Type UnspecifiedRAILROAD MEDICARE
NC5902965Medicaid