Individual
MR. PRENTISS LEE SMITH SR.
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
108 LANCE ALWORTH DR, BROOKHAVEN, MS 39601-2300
(601) 833-8511
(601) 835-5413
Mailing address
PO BOX 764, BROOKHAVEN, MS 39602-0764
(601) 833-8511
(601) 835-5413
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
06251
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016651
—
MS
Enumeration date
10/25/2005
Last updated
07/08/2007
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