Provider Demographics
NPI:1134435480
Name:SMITH, WILLIAM T
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:T
Last Name:SMITH
Suffix:
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 1:6721 WASHINGTON AVE APT 11F
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-2136
Mailing Address - Country:US
Mailing Address - Phone:614-478-3938
Mailing Address - Fax:
Practice Address - Street 1:6721 WASHINGTON AVE APT 11F
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-2136
Practice Address - Country:US
Practice Address - Phone:614-478-3938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN329811163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine