Individual
JENIQUA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
815 BELMONT ST, VICKSBURG, MS 39180-3827
(601) 218-2551
Mailing address
815 BELMONT ST, VICKSBURG, MS 39180-3827
(601) 218-2551
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
06/09/2016
Last updated
06/09/2016
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