Provider Demographics
NPI:1376531368
Name:SMITH, MILTON SHELBY (MD, FAAP)
Entity Type:Individual
Prefix:DR
First Name:MILTON
Middle Name:SHELBY
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 RAWLS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-2852
Mailing Address - Country:US
Mailing Address - Phone:601-684-8050
Mailing Address - Fax:601-684-7247
Practice Address - Street 1:300 RAWLS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2852
Practice Address - Country:US
Practice Address - Phone:601-684-8050
Practice Address - Fax:601-684-7247
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS05324208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00115203Medicaid
LA1165506Medicaid