Basic Information
| Provider Information | |||||||||
| NPI: | 1740264324 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | JEWELL | ||||||||
| MiddleName: | GEORGE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 24023 | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392254023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016073033 | ||||||||
| FaxNumber: | 6018534939 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 HIGHLAND COLONY PARKWAY | ||||||||
| Address2: | SUITE G | ||||||||
| City: | RIDGELAND | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391578813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016073033 | ||||||||
| FaxNumber: | 6018534939 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2005 | ||||||||
| LastUpdateDate: | 04/26/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | 05158 | MS | Y | Allopathic & Osteopathic Physicians | Plastic Surgery |
No ID Information.