Individual
JACKIE L SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T., D.P.T.
Contact information
Practice address
1110 S ADAMS ST, FULTON, MS 38843-8952
(662) 862-4104
(662) 862-4162
Mailing address
2416 HIGHWAY 45 N, COLUMBUS, MS 39705-1320
(662) 327-6705
(662) 327-6760
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT4406
MS
Other
Enumeration date
02/05/2016
Last updated
03/13/2017
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