Provider Demographics
NPI:1063406809
Name:SMITH, CHERYL A (MD)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:A
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:406 ROBERTSON BLVD
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-2756
Mailing Address - Country:US
Mailing Address - Phone:843-782-5437
Mailing Address - Fax:843-782-4269
Practice Address - Street 1:406 ROBERTSON BLVD
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-2756
Practice Address - Country:US
Practice Address - Phone:843-782-5437
Practice Address - Fax:843-782-4269
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25971208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC259712Medicaid