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NPI Code Detail

MEDICARE: CHILDREN'S MEDICAL GROUP, P.A.

MEDICARE: CHILDREN'S MEDICAL GROUP, P.A.
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
1208000000XPediatrics Physician

General Provider Information

NPI Number : 1588700603
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHILDREN'S MEDICAL GROUP, P.A.
Provider Business Mailing Address
First Line : 1867 CRANE RIDGE DR STE 101B
Second Line :
City : JACKSON
State : MS
Zip : 39216-4956
Country : US
Telephone Number : 601-362-8776
Fax Number : 601-354-8786
Provider Business Practice Location Address
First Line : 1867 CRANE RIDGE DR STE 101B
Second Line :
City : JACKSON
State : MS
Zip : 39216-4956
Country : US
Telephone Number : 601-362-8776
Fax Number : 601-354-8786
Authorized Official
Title or Position : PRESIDENT
Name : DR. WILLIAM H. SMITH JR.
Credential : M.D.
Telephone Number : 601-856-5105
Provider Enumeration Date : 01/29/2007
Last Update Date : 08/22/2020

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