Provider Demographics
NPI:1164406534
Name:SMITH, DANIEL EDWARD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:EDWARD
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5146 HIGHWAY 18
Mailing Address - Street 2:
Mailing Address - City:PACHUTA
Mailing Address - State:MS
Mailing Address - Zip Code:39347-5031
Mailing Address - Country:US
Mailing Address - Phone:865-246-8543
Mailing Address - Fax:
Practice Address - Street 1:5146 HIGHWAY 18
Practice Address - Street 2:
Practice Address - City:PACHUTA
Practice Address - State:MS
Practice Address - Zip Code:39347-5031
Practice Address - Country:US
Practice Address - Phone:865-246-8543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0237692084P0800X
CODR.00639962084P0800X
MS315362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO029079OtherKAISER COMMERCIAL NUMBER