Individual
JILLIAN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-1000
Mailing address
72 LEWALLEN DR, PURVIS, MS 39475-3652
(769) 223-3232
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
27890
MS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/03/2018
Last updated
10/13/2020
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