Individual
STEPHANIE LEE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC/L
Contact information
Practice address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 264-5203
(601) 264-5203
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 264-5203
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT0434
MS
Other
Enumeration date
06/18/2017
Last updated
07/21/2022
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