Provider Demographics
NPI:1558118489
Name:SMITH, ADELIA FEASTER
Entity type:Individual
Prefix:MS
First Name:ADELIA
Middle Name:FEASTER
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 HILLBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:PACOLET
Mailing Address - State:SC
Mailing Address - Zip Code:29372-2435
Mailing Address - Country:US
Mailing Address - Phone:864-327-5310
Mailing Address - Fax:
Practice Address - Street 1:371 HILLBROOK CIR
Practice Address - Street 2:
Practice Address - City:PACOLET
Practice Address - State:SC
Practice Address - Zip Code:29372-2435
Practice Address - Country:US
Practice Address - Phone:864-435-3474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-30
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC236175163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty