Provider Demographics
NPI:1255678033
Name:SMITH, LIONEL JR
Entity Type:Individual
Prefix:MR
First Name:LIONEL
Middle Name:
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 NEW ORLEANS BLVD APT 203
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70364-3320
Mailing Address - Country:US
Mailing Address - Phone:985-873-9788
Mailing Address - Fax:
Practice Address - Street 1:139 NEW ORLEANS BLVD APT 203
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70364-3320
Practice Address - Country:US
Practice Address - Phone:985-873-9788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker