Provider Demographics
NPI:1134845613
Name:SNIDER, JOHN N I
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:N
Last Name:SNIDER
Suffix:I
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 1:50585 ATHENS QUINCY RD
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MS
Mailing Address - Zip Code:39730-9643
Mailing Address - Country:US
Mailing Address - Phone:662-315-9530
Mailing Address - Fax:
Practice Address - Street 1:50585 ATHENS QUINCY RD
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MS
Practice Address - Zip Code:39730-9643
Practice Address - Country:US
Practice Address - Phone:662-315-9530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program