Provider Demographics
NPI:1639306756
Name:SMITH, THOMAS JR JR (AT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JR
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:AT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:790 ROBERTS DR
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71655-5723
Mailing Address - Country:US
Mailing Address - Phone:870-367-9732
Mailing Address - Fax:870-460-6133
Practice Address - Street 1:1802 HWY 82 WEST
Practice Address - Street 2:
Practice Address - City:CROSSETT
Practice Address - State:AR
Practice Address - Zip Code:71635
Practice Address - Country:US
Practice Address - Phone:870-364-7248
Practice Address - Fax:870-364-2249
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator