Healthcare Provider Details

I. General information

NPI: 1306126313
Provider Name (Legal Business Name): CARRIE M SMITH AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 JOHN EVERETT RD
MOSELLE MS
39459-9771
US

IV. Provider business mailing address

3 JOHN EVERETT RD
MOSELLE MS
39459-9771
US

V. Phone/Fax

Practice location:
  • Phone: 601-475-9304
  • Fax:
Mailing address:
  • Phone: 601-475-9304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA3610
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: