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General NPI Number Information
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NPI Number | 1912433459
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Entity Type | Organization
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Legal Business Name | S&M MEDICAL CLINIC
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Dates
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Enumeration Date | 05/03/2017
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Last Update Date | 05/03/2017
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Provider Practice Location Address
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Address Line | 403 NORTHWEST DEPOT STREET
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City | DURANT
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State | MS
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Zip | 39063
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Country | US
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Telephone | 662-633-9633
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Fax |
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Provider Business Mailing Address
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Address Line | 57 BAILEY ST
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City | DURANT
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State | MS
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Zip | 39063
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Country | US
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Telephone | 662-633-9633
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LATONYA SMITH
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Credential | BA DEGREE
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Telephone | 662-633-9633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State | MS
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