Healthcare Provider Details

I. General information

NPI: 1801979141
Provider Name (Legal Business Name): DEBORAH B SMITH MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 INDUSTRIAL PARK RD
LUCEDALE MS
39452
US

IV. Provider business mailing address

3407 SHAMROCK COURT
GAUTIER MS
39553
US

V. Phone/Fax

Practice location:
  • Phone: 601-947-4274
  • Fax: 601-947-4275
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: