Individual
LEAH NICHOLE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3502 W NORTHSIDE DR, JACKSON, MS 39213-4454
(601) 362-5321
Mailing address
3502 W NORTHSIDE DR, JACKSON, MS 39213-4454
(601) 362-5321
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
22496
MS
208000000X
Pediatrics Physician
22496
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04801059
—
MS
Enumeration date
07/02/2013
Last updated
10/30/2013
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