Provider Demographics
NPI:1275531881
Name:SMITH, NORWOOD M (MD)
Entity Type:Individual
Prefix:DR
First Name:NORWOOD
Middle Name:M
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1860 CHADWICK DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204-3463
Mailing Address - Country:US
Mailing Address - Phone:601-373-6441
Mailing Address - Fax:601-373-5715
Practice Address - Street 1:1860 CHADWICK DR
Practice Address - Street 2:SUITE B
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-3463
Practice Address - Country:US
Practice Address - Phone:601-373-6441
Practice Address - Fax:601-373-5715
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS119182085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00116841Medicaid
MS300064586OtherRAILROAD MEDICARE
MS300064586OtherRAILROAD MEDICARE
MS00116841Medicaid
MS300000402Medicare PIN
MS300000402Medicare ID - Type Unspecified