Individual
ANTONETTE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
216 SPRUCE ST, BROOKHAVEN, MS 39601-3385
(601) 695-1371
Mailing address
PO BOX 3775, BROOKHAVEN, MS 39603-7775
(601) 695-1371
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
07/15/2014
Last updated
07/15/2014
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