Provider Demographics
NPI:1871770891
Name:SMART, JENNIFER L (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:SMART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:ORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10701 ANDERSON RD
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-9309
Mailing Address - Country:US
Mailing Address - Phone:864-295-2500
Mailing Address - Fax:864-295-2506
Practice Address - Street 1:10701 ANDERSON RD
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-9309
Practice Address - Country:US
Practice Address - Phone:864-295-2500
Practice Address - Fax:864-295-2506
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8349207Q00000X
ALMD28989207Q00000X
SC37986207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL106953Medicaid
AL510I080489Medicare PIN
AL106953Medicaid
TXD05150Medicare PIN
TX335077YMNTMedicare PIN