MEDICARE: MR. LEROY SMITH JR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246RM2200X	Medical Laboratory Technician

General Provider Information

NPI Number	:	1477404143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LEROY SMITH JR.

Provider Business Mailing Address
First Line	:	4223 WILL O RUN DR
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39212-3421
Country	:	US
Telephone Number	:	682-377-3203
Fax Number	:

Provider Business Practice Location Address
First Line	:	4223 WILL O RUN DR
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39212-3421
Country	:	US
Telephone Number	:	682-377-3203
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2026
Last Update Date	:	02/06/2026

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Directions to “ MR. LEROY SMITH JR. ” Practice Location

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