Individual
DR. CHANNING MARSHALL SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
214 N. WEST AVE, JACKSON, MI 49201-1903
(517) 784-9189
(517) 784-9657
Mailing address
214 N. WEST AVE, JACKSON, MI 49201-1903
(517) 784-9189
(517) 784-9657
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301077287
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0120167
PHYSICIAN HEALTH PLAN
MI
01
—
0803802382
BCBSM
MA
05
—
4297133
—
MI
Enumeration date
07/20/2006
Last updated
03/06/2015
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