Smith grew up in Birmingham, Alabama. He got his nickname because he liked climbed in trees. He played at house parties and in 1920 moved to Pittsburgh, Pennsylvania, where he went to work as an entertainer. He was active in the vaudevillecircuit as a singer, comedian and pianist and accompanied blues singer Ma Rainey and Butterbeans and Susie. At the suggestion of pianist Cow Cow Davenport , he moved to Chicago with his wife and child in 1928, where he briefly lived in the same House as Meade Lux Lewis and Albert Ammons. With these men, he played occasionally in nightly jam sessions.
On 29 december 1928 he took for "Pine Top's Boogie Woogie ' Vocalion on, one of the first boogiewoogiehits and the first plate on which the term ' Boogie-Woogie ' was mentioned. The theme for the song he had due to a song by Jimmy Blythe.
He made a few recordings in January and would appear again in the studio in March 1929, but was the day before the session during a fight in a Dancehall hit by a stray bullet. Downbeat reported in a famous headline: "I saw Pinetop spit blood".
By Pinetop Smith surrendered, but only eleven recordings are Clarence had a great influence on other musicians, such as Albert Ammons and Pete Johnson. Tommy Dorsey took "Pine Top's Boogie Woogie on the late 1930s '. In the 1950s took Joe Willie Perkins, later pianist of Muddy Waters, the song also and with success: he was thereafter known as Pinetop Perkins and at some point everyone thought that this song was written by him. Bob Thiele called a jazz album with his Orchestra ' I saw Pinetop spit blood ". The lp included an adaptation of Smith's famous number.