Healthcare Provider Details

I. General information

NPI: 1043211642
Provider Name (Legal Business Name): PAUL EUGENE SMITH CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 SERGEANT PRENTISS DR
NATCHEZ MS
39120-4726
US

IV. Provider business mailing address

806 GRANT ST
SUMMIT MS
39666-9041
US

V. Phone/Fax

Practice location:
  • Phone: 601-443-2100
  • Fax:
Mailing address:
  • Phone: 601-276-7759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR673722
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: