Individual
MR. VICTOR ONEIL SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CEO/COO
Contact information
Practice address
121 COLONIAL GLN, JACKSON, MS 39211-3305
(601) 573-8651
Mailing address
121 COLONIAL GLN, JACKSON, MS 39211-3305
(601) 573-8651
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
421763537
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
421763537
501 (C) (3) ORGANIZATION
MS
Enumeration date
11/26/2015
Last updated
11/26/2015
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