Individual
EDWARD L SMITH SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9127 CORPORATE DR, SOUTHAVEN, MS 38671-1243
(662) 812-3685
Mailing address
9127 CORPORATE DR, SOUTHAVEN, MS 38671-1243
(662) 812-3685
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
—
—
235Z00000X
Speech-Language Pathologist
Primary
S-2758
MS
Other
Enumeration date
05/13/2024
Last updated
07/21/2024
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