Provider Demographics
NPI:1952612871
Name:SMITH, KEYOKA SHEREE (DPM)
Entity type:Individual
Prefix:DR
First Name:KEYOKA
Middle Name:SHEREE
Last Name:SMITH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SUMMERLEA LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-3915
Mailing Address - Country:US
Mailing Address - Phone:843-409-3201
Mailing Address - Fax:
Practice Address - Street 1:4100 N MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-5800
Practice Address - Country:US
Practice Address - Phone:803-570-2209
Practice Address - Fax:888-866-4740
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001211213ES0103X
NY65 006369213ES0103X
SC622213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPD6229Medicaid
SCPD6229Medicaid
GA202I480245Medicare PIN