Provider Demographics
NPI:1922148162
Name:SMITH, SIDNEY KENDRICK III (MD)
Entity Type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:KENDRICK
Last Name:SMITH
Suffix:III
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 1:3901 HOUMA BLVD STE 401
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2930
Mailing Address - Country:US
Mailing Address - Phone:504-889-1448
Mailing Address - Fax:504-885-8752
Practice Address - Street 1:3901 HOUMA BLVD STE 401
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2930
Practice Address - Country:US
Practice Address - Phone:504-889-1448
Practice Address - Fax:504-889-1452
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0177612084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1905615Medicaid
LA1905615Medicaid
LAP01316231Medicare PIN
LA338441YYSXMedicare PIN
LA52076D670Medicare PIN