Individual
RICO SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
314 E GREEN ST, MACON, MS 39341-2850
(662) 228-1435
Mailing address
314 E GREEN ST, MACON, MS 39341-2850
(662) 228-1435
Taxonomy
Speciality
Code
Description
License number
State
103TP0016X
Prescribing (Medical) Psychologist
Primary
2728292
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
84-2217156
—
MS
Enumeration date
03/19/2020
Last updated
03/20/2020
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