Individual
MR. JOHNATHON CRAWFORD SMITH SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CLPN
Contact information
Practice address
165 BANKHEAD RD SW, MANTACHIE, MS 38855-7267
(662) 840-1944
Mailing address
165 BANKHEAD ROAD, MANTACHIE, MS 38855-7265
(662) 840-1944
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
P231371
MS
Other
Enumeration date
01/03/2008
Last updated
01/03/2008
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