Provider Demographics
NPI:1154359842
Name:SMITH RAYFORD, EDITH FAYE (MD)
Entity type:Individual
Prefix:DR
First Name:EDITH
Middle Name:FAYE
Last Name:SMITH RAYFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 WINTER ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204-2841
Mailing Address - Country:US
Mailing Address - Phone:601-948-5572
Mailing Address - Fax:601-353-7070
Practice Address - Street 1:1134 WINTER ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-2841
Practice Address - Country:US
Practice Address - Phone:601-948-5572
Practice Address - Fax:601-353-7070
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13352207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00117048Medicaid
MS251850Medicare Oscar/Certification
MS251933Medicare Oscar/Certification
MSF43197Medicare UPIN
MSC01051Medicare Oscar/Certification
MS00117048Medicaid
MS160000600Medicare PIN