Healthcare Provider Details

I. General information

NPI: 1306870662
Provider Name (Legal Business Name): CLINTON R. SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 N STATE ST STE 100
JACKSON MS
39202-2064
US

IV. Provider business mailing address

350 N HUMPHREYS BLVD
MEMPHIS TN
38120-2177
US

V. Phone/Fax

Practice location:
  • Phone: 601-714-6400
  • Fax: 601-714-6499
Mailing address:
  • Phone: 901-226-4003
  • Fax: 901-227-8591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number18558
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: