Healthcare Provider Details

I. General information

NPI: 1386567980
Provider Name (Legal Business Name): SMITH LAB TESTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 J C BRISTER RD LOT 2
TYLERTOWN MS
39667-6636
US

IV. Provider business mailing address

4780 I 55 N STE 116
JACKSON MS
39211-6067
US

V. Phone/Fax

Practice location:
  • Phone: 601-551-7623
  • Fax: 775-259-8481
Mailing address:
  • Phone: 601-551-7623
  • Fax: 775-259-8481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MS. DEUNDRA SMITH
Title or Position: SPECIMEN COLLECTOR
Credential:
Phone: 601-551-7623