Provider Demographics
NPI:1497583108
Name:SMITH, JADON LANTRELL (MBA)
Entity type:Individual
Prefix:
First Name:JADON
Middle Name:LANTRELL
Last Name:SMITH
Suffix:
Gender:M
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 RODENBERG AVE
Mailing Address - Street 2:B
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531
Mailing Address - Country:US
Mailing Address - Phone:228-281-6306
Mailing Address - Fax:
Practice Address - Street 1:274 RODENBERG AVE
Practice Address - Street 2:B
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531
Practice Address - Country:US
Practice Address - Phone:228-281-6306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver