Healthcare Provider Details

I. General information

NPI: 1962029751
Provider Name (Legal Business Name): LYNNE E SMITHHART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 EAST WOODROW WILSON
JACKSON MS
39216
US

IV. Provider business mailing address

2 SANDALWOOD DRIVE
MADISON MS
39110
US

V. Phone/Fax

Practice location:
  • Phone: 601-985-2193
  • Fax:
Mailing address:
  • Phone: 601-750-4654
  • Fax: 601-362-3153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC5905
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: