Provider Demographics
NPI:1841060555
Name:SMITH, MICHAEL (GENERAL CONTRACTOR)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:GENERAL CONTRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 BERTHA MARIE LN
Mailing Address - Street 2:
Mailing Address - City:WADMALAW ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29487-7188
Mailing Address - Country:US
Mailing Address - Phone:843-475-3511
Mailing Address - Fax:
Practice Address - Street 1:1640 BERTHA MARIE LN
Practice Address - Street 2:
Practice Address - City:WADMALAW ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29487-7188
Practice Address - Country:US
Practice Address - Phone:843-475-3511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC117506171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Multi-Specialty