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NPI Code Detail

MEDICARE: CLINTON R. SMITH M.D.

MEDICARE: CLINTON R. SMITH M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician18558MS

General Provider Information

NPI Number : 1306870662
Entity Type Code : Individual
Provider Name (Legal Business Name) : CLINTON R. SMITH M.D.
Provider Business Mailing Address
First Line : 350 N HUMPHREYS BLVD
Second Line :
City : MEMPHIS
State : TN
Zip : 38120-2177
Country : US
Telephone Number : 901-226-4003
Fax Number : 901-227-8591
Provider Business Practice Location Address
First Line : 1225 N STATE ST STE 100
Second Line :
City : JACKSON
State : MS
Zip : 39202-2064
Country : US
Telephone Number : 601-714-6400
Fax Number : 601-714-6499
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2006
Last Update Date : 05/04/2026

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