Provider Demographics
NPI:1972756609
Name:ROY E. SMITH, M.D.
Entity type:Organization
Organization Name:ROY E. SMITH, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LANIER-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:803-425-1330
Mailing Address - Street 1:1111 MILL ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-3763
Mailing Address - Country:US
Mailing Address - Phone:803-425-1330
Mailing Address - Fax:803-425-1337
Practice Address - Street 1:1111 MILL ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-3763
Practice Address - Country:US
Practice Address - Phone:803-425-1330
Practice Address - Fax:803-425-1337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15151207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC151515Medicaid
SCE74734Medicare UPIN
SC151515Medicaid