Smith, Randall S

Smith, Randall S is an individual health care provider with primary practice located at 969 Lakeland Drive , Jackson MS 39216-4699. He recently has only one registered license in Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology, which is considered as his primary health care specialty. Smith, Randall S can be contacted via phone (601) 200-3840.

Contact Information

Primary practice address
969 Lakeland Drive Jackson MS 39216-4699
Phone: (601) 200-3840
Fax: (601) 200-8801
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology 207ZP0102X 13000 Mississippi

Profile Details

NPI number 1760457980
LBN Legal business name Smith, Randall S
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 21st, 2006
Last updated Sep 25th, 2014 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1760457980 NPPES
Mississippi MEDICAID 05774275
Mississippi Other 981416
Mississippi Other 4227432
Mississippi Other P00305343

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